Enhanced tool for organized reporting in CT scans could potentially enhance hernia identification post-bariatric surgery.

In a groundbreaking study, researchers from Northwestern University Feinberg School of Medicine in Chicago, led by Joseph Sanchez, MD, have found that a structured CT reporting tool may significantly improve the detection of internal hernias in patients who have undergone Roux-en-Y gastric bypass (RYGB) surgery.

The study, aimed at preventing missed internal hernias as a potential cause of abdominal pain in RYGB patients, compared the findings of two groups. The pre-intervention group consisted of 139 CT scans, while the post-intervention group had 193 scans, with the tool being applied to 49.7% of the latter.

Before the implementation of the tool, radiology residents, abdominal radiology fellows, emergency radiology, and abdominal radiology attendings received education on the detection of internal hernias via CT scanning. Prior to this, six internal hernias (3.7%) were missed by CT in the pre-intervention group, compared to just two (1.1%) in the post-intervention group.

Interestingly, the study found that certain components of the structured CT reporting tool had variable sensitivities and specificities. However, the tool, when used, may help improve the sensitivity for internal hernia detection following RYGB surgery, as the sensitivity increased from 40% in the pre-intervention group to 75% in the post-intervention group.

The tool incorporates certain signs of internal hernia directly into CT reads and impressions, such as the mesenteric swirl pattern, mesenteric edema, or an abnormal superior mesenteric vein, and bowel loops located posterior to the Roux loop mesentery.

The study also highlighted that RYGB patients may be mistakenly diagnosed with reflux disease, gastritis, gallstone disease, or marginal ulcer in hospital emergency departments. This underscores the importance of the structured CT reporting tool in ensuring accurate diagnoses.

It is important to note that although the tool has shown promising results, surgeons still play an important role in making a clinical diagnosis of internal hernia, as not all CT scans will accurately diagnose an internal hernia.

The structured CT reporting tool, developed in May 2023, was optional for individual radiologists to use. The complete paper discussing this study can be found here. The American College of Radiology (ACR) is the institution that designed the development of the structured CT reporting template to prevent missed internal hernias in patients with a history of Roux-en-Y gastric bypass surgery.

The study suggests that radiologists have come to prefer structured CT reporting tools over free-text reports, and this finding supports the idea that such tools may aid in the evaluation of internal hernias following RYGB. The high specificity of the tool, remaining at 99.2% in the pre-intervention group and 98.9% in the post-intervention group, further supports its potential usefulness.

In conclusion, the study provides evidence that a structured CT reporting tool may help improve the detection of internal hernias in patients who have undergone RYGB surgery. However, further research and clinical implementation are needed to fully understand its impact on patient outcomes.

Enhanced tool for organized reporting in CT scans could potentially enhance hernia identification post-bariatric surgery.