Mesenteric swirl on angiotomography of a patient with Petersen's hernia and apparent mesenteric thrombosis
Keywords:
Petersen's hernia, mesenteric thrombosis, computed tomography.Abstract
Introduction: Diagnostic images are essential for the diagnosis of mesenteric vein thrombosis and Petersen's hernia.Objective: To describe the treatment of a patient who presented apparent thrombosis of the mesenteric vein and Petersen's hernia on angiotomography.
Clinical case: A patient consulted for colicky abdominal pain predominantly in the epigastrium, radiating to the dorsal region. Due to the clinical picture suggestive of vascular emergency, an angiotomography of the vessels of the thorax and abdomen was immediately requested. The images revealed patency of the superior mesenteric artery at its origin and in the proximal third, appreciating a vessel turn (swirl sign) approximately 7 cm from its origin with apparent complete occlusion due to thrombosis. In the same place where the twisting of the vessels was evident, the initiation of apparent thrombosis of the superior mesenteric vein was appreciated. A surgical procedure was performed in which Petersen's space and herniation of the entire small intestine through this space were found. The laparotomy showed that the patient did not have thrombosis at any time, but that it was an effect given by the image and the finding that was seen was secondary to Petersen's hernia.
Conclusions: The presence of the swirl sign on an angiotomography is very important but not definitive in the diagnosis of Petersen's hernia.
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References
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2. Miyagaki H, Takiguchi S, Kurokawa Y, Hirao M, Tamura S, Nishida T, et al. Recent trend of internal hernia occurrence after gastrectomy for gastric cancer. World J Surg. 2012; 36(4): 851-7. DOI: 10.1007/s00268-012-1479-2
3. Geubbels N, Lijftogt N, Fiocco M, van Leersum NJ, Wouters MW, de Brauw LM. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015; 102(5): 451-60. DOI: 10.1002/bjs.9738
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5. Blachar A, Federle MP, Pealer KM, Ikramuddin S, Schauer PR. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002; 223(3): 625-32. DOI: 10.1148/radiol.2233011323
6. Erdem K, Sabri AS. Malrotation Induced Small Intestine Ischemia in an Adolescent. Case Rep Surg. 2017; 2017: 4809406. DOI: 10.1155/2017/4809406
7. Orzech N, Navarro OM, Langer JC. Is ultrasonography a good screening test for intestinal malrotation? J Pediatr Surg. 2006; 41(5): 1005-9. DOI: 10.1016/j.jpedsurg.2005.12.070
8. Blumberg SN, Maldonado TS. Mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2016; 4(4):501-7. DOI: 10.1016/j.jvsv.2016.04.002
9. Parakh S, Soto E, Merola S. Diagnosis and management of internal hernias after laparoscopic gastric bypass. Obes Surg. 2007; 17(11): 1498-502. DOI: 10.1007/s11695-008-9429-7
Published
2022-04-02
How to Cite
1.
Ardila CM, Zuluaga-Gomez M, Giraldo-Campillo D, Gonzalez-Arroyave D. Mesenteric swirl on angiotomography of a patient with Petersen’s hernia and apparent mesenteric thrombosis. Rev Cubana Med Milit [Internet]. 2022 Apr. 2 [cited 2025 Apr. 19];51(2):e02201795. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/1795
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