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Swirl Sign After Roux-en-Y Gastric Bypass: CT Recognition of Internal Hernia and Small-Bowel Volvulus

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A radiologic approach to a potentially life-threatening postoperative complication By Dr. SB Lee Executive Answer In a patient with previous Roux-en-Y gastric bypass who presents with acute abdominal pain, nausea, and bilious vomiting, a mesenteric swirl sign on CT should immediately raise concern for internal hernia with small-bowel obstruction and possible volvulus . In this case, dilated distal small-bowel loops, proximal decompression, and twisting of bowel and mesenteric vessels were associated with herniation through a mesenteric defect near the jejunojejunostomy. Exploratory laparoscopy confirmed an internal hernia, which was reduced and repaired. The key radiologic lesson is that altered postoperative anatomy should not obscure recognition of abnormal bowel configuration and mesenteric vascular rotation. Why This Case Matters Internal hernia is an important late complication of Roux-en-Y gastric bypass (RYGB). Unlike an external hernia, there may be no obvious abdominal wall ab...
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Acute MCA M2 Occlusion With Contralateral Hemiplegia and Aphasia: CT and CTA Imaging, Clinical Reasoning, and Stroke AI

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Executive Answer Acute right-sided hemiplegia and expressive aphasia should immediately raise concern for a left middle cerebral artery (MCA) stroke, particularly when CT angiography (CTA) demonstrates an acute M2 segment occlusion. In this case, a woman in her 60s with chronic atrial fibrillation developed acute right-sided neurologic deficits after warfarin had been temporarily discontinued for an elective implantable cardioverter-defibrillator procedure. Noncontrast CT and CTA were used to evaluate hemorrhage, early ischemic change, and the site of arterial occlusion. CTA demonstrated an acute left MCA M2 occlusion that anatomically corresponded to the patient's clinical deficits. The case illustrates a central principle of acute stroke imaging: identifying the occluded vessel is only the beginning; the radiologist must rapidly connect vascular anatomy, threatened brain tissue, treatment eligibility, and time-to-reperfusion. Why This Case Matters Acute ischemic stroke is fundame...
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CT Diagnosis of De Garengeot Hernia with Concurrent Appendicitis: A High-Risk Femoral Hernia You Must Not Miss

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Edited by ScholarGen MediAI Team Executive Answer De Garengeot hernia is a rare form of femoral hernia containing the appendix, and when complicated by appendicitis, it becomes a time-critical surgical condition. The key CT finding is a blind-ending tubular structure within the femoral canal , often accompanied by fat stranding, fluid, and femoral vein compression . This diagnosis matters because it is frequently mistaken for a simple incarcerated hernia, leading to delayed treatment. Early CT recognition directly determines surgical urgency and patient outcome. Why This Case Matters Right groin pain with swelling is commonly attributed to a typical hernia. However, this case represents a diagnostic trap with high clinical consequences . A missed diagnosis can lead to: Appendiceal perforation Peritonitis Sepsis Increased mortality risk The central lesson is not rarity—it is recognition under pressure in real clinical workflow . Clinical Scenario A...
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