E5379. The Enigma of Internal Hernias: Surgeons' Role in Deciphering the Code
  1. Joshua Barnaby; Nassau University Medical Center
  2. Madhu Oad; Nassau University Medical Center
  3. Dahua Zhou; Nassau University Medical Center
Assessing internal hernias radiologically can present a formidable challenge to even the most seasoned radiologist. While the manifestations of an internal hernia can often be evident with bowel obstruction and twisting/swirling of the mesentery, the complexity arises from the diverse spectrum of internal hernia types and their intricate interplay among the abdominal compartments, often making the final diagnosis elusive. The fundamental objective of this exhibit is to showcase a series of unknown cases of internal hernias and juxtapose the radiological observations with the intraoperative findings made by the surgical team. By providing a multidisciplinary approach, we aim to delve deeper into comprehending the nuances involved in these challenging cases and ultimately improve the diagnostic precision of the learner.

Educational Goals / Teaching Points
Multiple unknown cases will be presented along with the preoperative radiological findings of various types of internal hernias, coupled with the postoperative findings reported by the operating surgeons. The aim of the exhibit is to help simplify this intricate subject matter by providing the radiologist with intraoperative insight. This approach aims to solidify the radiographic appearance of a variety of internal hernias, their diverse presentations, and intimate relationship between the abdominal spaces and how they may be altered in the various hernia types. After this presentation the viewer should not only be able to recognize imaging features of internal hernias, but also have an improved proficiency in accurately diagnosing the specific type of internal hernia they are encountering.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The exhibit will employ the use of predominantly CT cases in a series of static images and concise video loops to effectively demonstrate diverse manifestations of internal hernias. The cases will exhibit the classic findings that are shared among internal hernias, discuss the classic locations in which internal hernias may occur (e.g., transmesenteric and paraduodenal), and depict some of the more unique locations/situations (e.g., Foramen of Winslow or Peterson’s space hernia). Each case will be coupled with postoperative findings obtained from direct conversation with the operative surgeon or extracted from their operative reports. This comprehensive pairing will allow radiologists a unique and unprecedented grasp of this entity, which would not be otherwise obtainable.

Internal hernias are one of the more challenging diagnoses to make accurately given their vast array of presentations and often vague imaging findings. We hope this presentation will allow the viewer to master the art of diagnosing internal hernias as an entity and appreciate how collaboration with our surgical counterparts can deepen our understanding through their insight.