Internal Hernia: Diagnosis and Treatment

  • Brandon LaBarge
  • Ann M. RogersEmail author


Internal hernias account for 5.8% of small bowel obstructions and if untreated have a high mortality rate. Gastric bypass and duodenal switch patients are at risk for such obstructions related to new mesenteric defects. Patients may present with pain, vomiting, abdominal distension, and peritoneal signs, although symptoms may be vague when the bowel intermittently incarcerates and then reduces. Because of altered bariatric anatomy, plain films may not detect internal hernia bowel obstructions. Contrast computed tomography (CT) is the test of choice and may show saclike masses of bowel or a mesenteric “swirl.” Definitive diagnosis and treatment is via diagnostic laparoscopy or laparotomy in selected cases.


Internal hernia Gastric bypass Bariatric surgery Abdominal pain Bowel obstruction 


  1. 1.
    Salar O, El-Sharkawy AM, Singh R, et al. Internal hernias: a brief review. Hernia. 2013;17(3):373–7.CrossRefGoogle Scholar
  2. 2.
    Martin L, Merkle E, Thompson W. Review of internal hernias: radiographic and clinical findings. Am J Roentgenol. 2006;186(3):703–17.CrossRefGoogle Scholar
  3. 3.
    Takeyama N, Gokan T, Ohgiya Y, et al. CT of internal hernias. Radiographics. 2005;25(4):997–1015.CrossRefGoogle Scholar
  4. 4.
    Parakh S, Soto E, Merola S. Diagnosis and management of internal hernias after laparoscopic gastric bypass. Obes Surg. 2007;17(11):1498–502.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryPenn State College of Medicine, Penn State Milton S. Hershey Medical CenterHersheyUSA
  2. 2.Department of SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA

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