Radiologic Findings of Retroanastomotic Hernia after Gastrojejunostomy

ABSTRACT

PURPOSE: To review the radiological findings of retroanastomotic hernia and to derive the useful US and CT criteria to assist in the diagnosis of the condition in patients who had previously undergone gastrojejunostomy. METHODS: During a recent period, 8 consecutive cases of retroanastomotic hernia were encountered. Of the patients involved, seven underwent US and CT imaging. The US and CT scans were reviewed retrospectively to determine the abnormal findings. Surgical confirmation was available in all cases. RESULTS: The efferent loop was herniated through the defect created behind the anastomosis in seven cases, and the afferent loop in one case. Retroanastomotic hernia was suggested prospectively in all cases. Among the seven cases of efferent loop herniation, the US and CT signs of retroanastomotic hernia included whirling of the mesenteric vessels, jejunal loops, and mesentery in the periumbilical abdomen (7/7); mural thickening of the herniated bowel loops (5/7); dilatation of the herniated bowel loops (2/7); and US showed decreased peristalsis of the herniated bowel loops (2/6). In one case, the US and CT signs of retroanastomotic hernia of the afferent loop included dilatation and whirling of a short length of the afferent loop behind the anastomosis. One out of the eight patients had reVersible bowel ischemia, and one had bowel necrosis. CONCLUSION: Retroanastomoic hernia is an important condition, and the US and CT findings might be used for its diagnosis.