Swirl Sign - A C T Angiogram Alarm Sign or Congenital Trans-Mesenteric Hernias

Area of Science:

• Gastroenterology
• Radiology
• Pediatric Surgery

Background:

• Congenital trans-mesenteric hernias (CTMHs) arise from mesenteric defects and predominantly affect pediatric patients.
• Adult presentations of CTMHs are often delayed and associated with significant morbidity and mortality due to bowel ischemia.
• Currently, no pathognomonic clinical signs exist for CTMHs, complicating early diagnosis.

Observation:

• A radiologist suspected CTMH in an adult patient based on the finding of abnormal swirling of the superior mesenteric artery on a CT angiogram.
• This specific finding, termed the "swirl sign," indicated a potential mesenteric abnormality.

Findings:

• The "swirl sign" on CT angiogram is a critical indicator for congenital trans-mesenteric hernias.
• This radiological sign can facilitate earlier diagnosis compared to conventional methods.

Implications:

• Prompt surgical consultation is recommended upon identification of the "swirl sign" to mitigate risks of bowel ischemia and associated complications.
• This case highlights the importance of recognizing subtle radiological findings for timely intervention in rare congenital anomalies.
• Enhanced diagnostic accuracy through advanced imaging like CT angiography can improve patient outcomes for CTMHs.