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Obesity Surgery
Published in: Obesity Surgery 8/2017

01-08-2017 | Original Contributions

Contribution of Computed Tomographic Imaging to the Management of Acute Abdominal Pain after Gastric Bypass: Correlation Between Radiological and Surgical Findings.

Authors: Pascale Karila-Cohen, Francesco Cuccioli, Pasquale Tammaro, Anne-Laure Pelletier, Daniel Gero, Jean-Pierre Marmuse, Jean-Pierre Laissy, Konstantinos Arapis

Published in: Obesity Surgery | Issue 8/2017

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Abstract

Background

We evaluated the diagnostic accuracy of first interpretations of computed tomographic (CT) images and blind interpretation using predefined CT signs in patients with previous Roux-en-Y gastric bypass (RYGBP) and acute abdominal pain.

Methods

We performed a retrospective chart review of patients with RYGBP who underwent surgical exploration from January 2009 to December 2014 for acute abdominal pain in our university institution, excluding patients without CT scan and comparing initial CT imaging interpretation with surgical findings. Two blinded radiologist specialists in bariatric imaging evaluated the CT images for seven previously reported CT signs. We then calculated the sensitivity and specificity of these signs and Cohen’s kappa inter-observer agreement for diagnosing internal hernia.

Results

Sixty-four patients had a recorded CT scan. The original CT interpretation showed that 26/64 (40%) patients had an accurate diagnosis. Cohen’s kappa coefficient for concordance between surgical exploration and first interpretation was 0.26. The image review showed an accurate diagnosis was obtained in 51/64 patients (79.6%) and 48/64 (75%) patients for the first and second reader, respectively (Cohen’s kappa coefficient = 0.67; 95% confidence interval = 0.52–0.76). The most prevalent sign indicating internal hernia was whirling of the mesentery (sensitivity = 82–91%; specificity = 79–93.1%).

Conclusions

CT is an important diagnostic tool for skilled readers for managing acute abdominal pain in patients with previous RYGBP. Experience in the abdominal and bariatric imaging and the use of predetermined CT image signs provided a high degree of accuracy and confidence. A low threshold for surgical exploration remains the gold standard of appropriate treatment.
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Metadata
Title
Contribution of Computed Tomographic Imaging to the Management of Acute Abdominal Pain after Gastric Bypass: Correlation Between Radiological and Surgical Findings.
Authors
Pascale Karila-Cohen
Francesco Cuccioli
Pasquale Tammaro
Anne-Laure Pelletier
Daniel Gero
Jean-Pierre Marmuse
Jean-Pierre Laissy
Konstantinos Arapis
Publication date
01-08-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2601-1

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