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Hooking intestine sign: a typical diagnostic CT finding of Petersen’s hernia

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Abstract

Purpose

To clarify typical diagnostic computed tomography (CT) findings of Petersen’s hernia for differentiation from other causes of internal hernia observed in patients having undergone gastrectomy with Roux-en-Y gastric bypass.

Methods

We retrospectively reviewed CT findings of internal hernia in patients who had undergone both gastrectomy and Roux-en-Y reconstruction and a second surgery for bowel obstruction. Thirteen patients with Petersen’s hernia and 6 with internal hernia other than Petersen’s hernia were investigated. Six CT findings, viz. whirl sign, mesenteric fat haziness, intestinal distension in the upper abdomen, herniated intestinal loop above the gastric level, middle/distal ileum courses downwards from the left hypochondrium, and hooking intestine sign, which means two or more intestines pass through the inner side of J-shaped vessels consisting of mesenteric vessels of the elevated jejunum, were scored and evaluated regarding their diagnostic performance.

Results

The hooking intestine sign showed the highest sensitivity, specificity and accuracy (100%, 100% and 100%). We could detect J-shaped vessels in all Petersen’s hernia patients. Inside the J-shaped vessels there were two or more intestinal tracts passing through in the Petersen’s hernia group. There was only transverse colon inside the J-shaped vessels in the control group.

Conclusion

The hooking intestine sign may be useful for diagnosing Petersen’s hernia on CT.

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Acknowledgements

This work was supported in part by Grants from Scientific Research Expenses for Health and Welfare Programs, the Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare, No. 15K09885, the Scientific Research Expenses for Health and Welfare Programs, No. 29-A-3 (Takashi Terauchi and Ukihide Tateishi: squad leaders), Practical Research for Innovative Cancer Control and Project Promoting Clinical Trials for Development of New Drugs by Japan Agency for Medical Research and Development (AMED).

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Authors and Affiliations

  1. Department of Radiology, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, Japan

    Wataru Yamashita, Kenji Nishida, Shuichi Kawada & Kouichi Mori

  2. Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, Japan

    Shinsuke Usui

  3. Department of Diagnostic Radiology and Nuclear Medicine, Graduate school of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan

    Wataru Yamashita, Jun Oyama, Akira Toriihara & Ukihide Tateishi

Authors
  1. Wataru Yamashita
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  2. Kenji Nishida
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  3. Shuichi Kawada
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  4. Kouichi Mori
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  5. Shinsuke Usui
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  6. Jun Oyama
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  7. Akira Toriihara
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  8. Ukihide Tateishi
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Corresponding author

Correspondence to Ukihide Tateishi.

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The authors declare that they have no conflict of interest.

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Yamashita, W., Nishida, K., Kawada, S. et al. Hooking intestine sign: a typical diagnostic CT finding of Petersen’s hernia. Jpn J Radiol 35, 718–723 (2017). https://doi.org/10.1007/s11604-017-0691-2

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  • DOI: https://doi.org/10.1007/s11604-017-0691-2

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