Podcast 681: Internal Hernias

Podcast 681: Internal Hernias

Contributor: Adam Barkin, MD

Educational Pearls:

  • Internal hernias, when bowel herniates through iatrogenic or congenital defect in mesentery, represent 1-6% of all small bowel obstructions
  • Mortality of strangulated internal hernias is over 50% due to bowel necrosis and sepsis
  • Intermittent symptoms presenting with nausea, vomiting, abdominal pain, abdominal distension
  • Increased risk in patients with gastric bypass, liver transplant, or laparascopic surgery
  • CT is very >90% sensitivity and specific in diagnosing SBO due to internal hernia
    • Mesenteric swirl is a classic radiology finding
  • Treatment with immediate surgical consultation for possible OR bowel decompression
  • Start on broad spectrum antibiotics with any signs of sepsis

References

Lanzetta MM, Masserelli A, Addeo G, et al. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. Acta Biomed. 2019;90(5-S):20-37. Published 2019 Apr 24. doi:10.23750/abm.v90i5-S.8344

Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186(3):703-717. doi:10.2214/AJR.05.0644

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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Episoder(1147)

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Podcast 703: Fever in Infants

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Podcast 702: Paralytic Awareness

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Podcast 700: Analgesics for Acute Musculoskeletal Pain

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Contributor: Aaron Lessen, MD Educational Pearls: Recent RCT compared pain relief in patients receiving five medications for acute musculoskeletal pain Acetaminophen 1000mg/ibuprofen 400 mg Acetam...

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Podcast 699: Pediatric Fingernail Avulsions

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Contributor: Aaron Lessen, MD Educational Pearls: Traditionally, fingernails were replaced after avulsion using sutures Sometimes artificial material was placed when the fingernail was not available ...

28 Jul 20213min

Podcast 698: Empathy, Burnout, and Patient Satisfaction

Podcast 698: Empathy, Burnout, and Patient Satisfaction

Contributor: Aaron Lessen, MD Educational Pearls: Survey of EM physicians to self-report empathy and burnout levels and correlated with patient satisfaction scores Patient satisfaction was not affect...

27 Jul 20212min

Podcast 697: Kounis Syndrome

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