Internal mimics hernias and their mimics: How would radiologists help?

PurposeTrying to define the most valuable radiological sign(s) for the diagnosis of internal hernias and their mimics; mainly cocoon syndrome and adhesions.ReviewNowadays with the increasing number of bariatric surgeries, the number of diagnosed internal hernias has increased significantly. Adhesions and cocoon syndrome are among the differential diagnosis. Although many signs were suggested for the diagnosis of such conditions, yet no single sign is enough to diagnose each of the above.Method and subjectsThis is a retrospective study. In a period of 32 consecutive months, from June 2010 to February 2013 a total of 240 patients were admitted with abdominal pain with signs of remittent or persistent intestinal obstruction. All cases are subjected to multislice CT examination. Several criteria are used to diagnose internal hernia. Informed consents were taken from all patients and organizational ethics committee were informed.ResultsThe age of the patients varies between 22 and 63 years with average age of 36 ± 2.3 years. Most of the patients were females with ratio of 2:1. Commonest presentation was abdominal pain present in all cases. The study diagnosed 13 cases/internal hernias, 14/adhesions, two cases/cocoon syndrome, two cases/intussusceptions and one case/malrotation. The most important signs used are Swirl’s sign, localized bowel gathering and segmental bowel dilatation.ConclusionA single sign is not enough for the diagnosis of internal hernia, rather the use of more than one sign is essential to narrow the differential diagnosis.Clinical relevance/applicationThe prevalence of internal hernia is increasing due to increased rate of operative abdominal intervention. Prompt radiological diagnosis is crucial to avoid unwanted surgery in a non-virgin abdomen.