Improving the accuracy of CT in diagnosing internal herniation after gastric bypass surgery

Obesity is a worldwide problem with a number of comorbidities. To reduce weight and subsequent disease burden bariatric (weight loss) surgery is performed. This thesis focused on the laparoscopic Roux-en-Y gastric bypass, a form of bariatric surgery during which the bowels are rearranged to slow digestion. Due to this rearrangement, the bowels can move more freely and an internal herniation can occur. These patients will present with abdominal pain, which is very non-specific. Since an internal herniation requires surgery, patients with a suspicion of internal herniation will get a CT scan to aid in the diagnosis. In this hospital the incidence of internal herniation was around 2,5%, however 13% of patients after a gastric bypass underwent a CT scan. The diagnosis was correct in 86.6% of these cases. This thesis searched for a method to optimize the diagnostic accuracy of the CT scan. To reduce uncertainty in the radiology report and further improve the diagnostic accuracy of CT scans a standardized reporting template with ten CT signs was implemented. The structured report increased accuracy to 93.1%.