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Should small sliding hiatal hernias be reported at CT colonography?
Perry J Pickhardt1, Cody J Boyce, David H Kim
1Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA. ppickhardt2@uwhealth.org
AJR. American Journal of Roentgenology
|March 24, 2011
Summary
Colonic distention during CT colonography (CTC) frequently causes small sliding hiatal hernias. These incidental findings should not be reported to prevent unnecessary medical interventions.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Sliding hiatal hernias are common, but their prevalence during CT colonography (CTC) is debated.
- Colonic distention is a key component of CTC, potentially affecting anatomical structures.
Purpose of the Study:
- To investigate if colonic distention during CTC induces incidental sliding hiatal hernias.
- To assess the prevalence and characteristics of these induced hernias.
Main Methods:
- Evaluated 3126 asymptomatic adults undergoing screening CTC with CO2 distention.
- Compared CTC findings with standard CT scans in 123 individuals and an external control group of 488 adults.
- Used Fisher exact test for statistical significance.
Main Results:
- Hiatal hernias detected in 47.8% of patients during CTC, predominantly small.
- Internal controls showed hernia resolution or reduction in 76.4% of cases upon non-distention CT.
- External control group had a significantly lower prevalence (23.8%) of hiatal hernias.
Conclusions:
- Colonic distention at CTC commonly induces small sliding hiatal hernias.
- These technique-induced hernias may lead to overdiagnosis and unnecessary procedures.
- Recommend against reporting incidental small sliding hiatal hernias found during CTC.
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