Relationship between Intraoperative Bile Culture Outcomes and Subsequent Postoperative Infectious Complications: A Retrospective Cohort Study.

The presence of positive bile culture during intraoperative procedures has been associated with elevated morbidity and mortality rates in hepatobiliopancreatic surgeries, contributing to increased healthcare expenditures. However, the precise impact of bactobilia on the development of postoperative complications remains uncertain due to existing disparities in the published literature. In this retrospective cohort study, we assessed 137 patients who underwent major hepatobiliopancreatic surgery to examine the relationship between intraoperative bile culture outcomes and subsequent postoperative infectious complications. Among patients with bactobilia, a significant 35.1% exhibited systemic or local infectious complications, whereas only 11.1% of those with negative culture results experienced any infectious complications (p = 0.002). Similarly, a notable difference was observed in the incidence of surgical site infections, with 24.3% in the bactobilia group compared to 7.9% in the negative culture group (p = 0.01). A total of 74 monomicrobial cultures with microbiological growth were isolated, predominantly featuring Gram-negative microorganisms, primarily Enterobacteriaceae in 49 cultures. Escherichia coli was identified in 37.8% of positive cultures, while Klebsiella pneumoniae was evident in 21.6%. Gram-positive microorganisms were present in 10 cultures, with Enterococcus emerging as the prevailing species. The logistic regression model identified a positive bile culture as an independent factor significantly associated with infection development (OR: 2.26; 95% confidence interval: 1.23-11; p = 0.02). Considering the limitations of the study, these findings underscore the critical importance of conducting bile cultures during the intraoperative phase to enable vigilant monitoring and prompt management of infectious complications.

Severe Sinus Dysfunction in the Context of Chronic Lithium Intoxication and Poorly Controlled Hypothyroidism.

Cardiotoxicity associated with lithium is not a common event; however, it is potentially life-threatening, manifesting electrocardiographically with sinoatrial blocks, high-degree atrioventricular blocks, QT prolongation, and ventricular tachyarrhythmias. This case report presents a patient with severe sinus dysfunction in a clinically severe presentation secondary to cardiogenic shock. The patient sought medical attention for a one-week history of non-anginal chest pain, dizziness without syncope, generalized weakness, and somnolence progressing to bedridden status in the days preceding hospital admission. Laboratory findings revealed elevated blood levels of lithium and thyroid-stimulating hormone (TSH), along with concomitant Acute Kidney Injury Network (AKIN) II acute kidney injury. Subsequently, the patient was admitted to the intensive care unit, where persistent extreme sinus bradycardia of 30 bpm (beats per minute) with sinus pauses without ischemic changes was observed. The patient received supportive treatment, including renal replacement therapy, resulting in complete recovery of hemodynamic status without the need for long-term cardiac conduction devices.

Stroke in a Patient With Antiphospholipid Syndrome.

Antiphospholipid syndrome (APS) is characterized by the occurrence of thrombotic events and/or obstetric complications in the presence of antiphospholipid antibodies. It is considered one of the most common acquired thrombophilias. The presentation of stroke in patients with APS has been described in some studies; however, it is not frequent enough and there is not much information available regarding the indications for pharmacological thrombolysis and the safety of thrombolytic treatment. Likewise, current evidence does not describe contraindications to thrombolytic therapy in cases of this diagnosis, which makes management with fibrinolysis safe in these cases. A clinical case of stroke is presented in which pharmacological thrombolysis is performed with a successful outcome, without complications of angioedema or bleeding. Likewise, concerning the case, the main neurological manifestations associated with APS, especially in its association with stroke, are described.

Predicting intensive care unit-acquired weakness: A multilayer perceptron neural network approach.

In this editorial, we comment on the article by Wang and Long, published in a recent issue of the World Journal of Clinical Cases. The article addresses the challenge of predicting intensive care unit-acquired weakness (ICUAW), a neuromuscular disorder affecting critically ill patients, by employing a novel processing strategy based on repeated machine learning. The editorial presents a dataset comprising clinical, demographic, and laboratory variables from intensive care unit (ICU) patients and employs a multilayer perceptron neural network model to predict ICUAW. The authors also performed a feature importance analysis to identify the most relevant risk factors for ICUAW. This editorial contributes to the growing body of literature on predictive modeling in critical care, offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.

Projectile Embolism From a Firearm Injury: A Case Report.

Projectile embolism resulting from firearm injuries is a rare but highly lethal complication when not diagnosed early. This report presents a case of projectile embolism from a firearm injury with an unusual entry site, the cerebral venous circulation, which subsequently migrates to the pulmonary circulation with a fatal outcome. A 24-year-old male patient was admitted to a high-complexity hospital due to a gunshot wound. A plain skull computed tomography (CT) revealed a left laminar subdural hematoma and traumatic subarachnoid hemorrhage with multiple metallic fragments embedded in the skull, some penetrating the galeal sinus, with perilesional bleeding. Contrast-enhanced chest tomography showed non-thrombotic embolism of metallic fragments in the pulmonary artery for the apical segment of the left upper lobe and right intraventricular regions. Transthoracic echocardiography revealed a hyperechoic image of 3 mm in the subvalvular apparatus toward the interventricular septum. Subsequently, the patient experienced neurological deterioration with signs of cerebral edema and parieto-occipital epidural hematomas with metallic fragments and projectiles. Measures to counteract cerebral edema were initiated. Later, the patient developed mydriasis, the absence of brainstem reflexes, and experienced cardiac arrest. This report delineates a case of projectile embolism, highlighting a distinctive aspect characterized by an unusual entry point.

Wernicke's Encephalopathy in a Patient With Type III Intestinal Failure: A Case Report.

This case is about a 38-year-old male patient with a history of type III intestinal failure due to chronic intestinal pseudo-obstruction caused by gastrointestinal dysmotility, cardiac and intestinal arrhythmia syndrome, dependence on parenteral nutrition, sinus dysfunction, and carrying a pacemaker. The patient presented with symptoms suggestive of a new episode of intestinal obstruction. A contrast-enhanced abdominal computed tomography scan was performed, revealing intestinal obstruction with a transition zone in the jejunum. Non-operative medical management of the obstructive condition was initiated. However, after 10 days of medical management, the patient began experiencing nausea and dizziness. Initially, symptomatic management was provided, but the patient reported persistent vertigo-like sensations. Following evaluation by multiple specialties, magnetic resonance imaging (MRI) was requested, which showed bilateral and symmetrical hyperintensity on T2-weighted images of the dorsomedial aspect of the thalami around the third ventricle, in the periaqueductal gray matter, the mesencephalic tectum, and, to a lesser extent, the bulbar tectum, findings suggestive of Wernicke's encephalopathy. Urgent intravenous thiamine replacement was initiated. After 10 days of effective treatment, the patient exhibited a nearly complete improvement in symptoms. A follow-up MRI was ordered, indicating considerable improvement when compared to the previous study.

PoCUS for the management of Fournier's gangrene in the emergency department: A case report.

Serious soft tissue infections in the spectrum of rapidly progressive necrosis of the fascia and subcutaneous tissue represent a clinical challenge in emergency department clinical practice. Fournier's gangrene (FG) is a presentation thereof that compromises the urogenital area. A low threshold of clinical suspicion complementary to laboratory evaluation and imaging is necessary to act rapidly and perform diagnostic and therapeutic surgical intervention for this condition. The present study reported the case of a 63-year-old woman who was admitted with buttock skin changes for 72 h. The diagnostic impression was septic shock due to FG. Point-of-care ultrasound (PoCUS) was performed, indicating free fluid in the muscle planes, discontinuity of the muscle fascia and the presence of gas in the subcutaneous cellular tissue. The patient was taken to surgery 2 h after admission. PoCUS was indicated to have an acceptable diagnostic performance that may optimize the care of this type of patient depending on the conditions of the emergency department and the availability of other resources.

Comparison of Outcomes and Survival of Two Cohorts of Patients with Simultaneous Pancreas-Kidney Transplantation: A Retrospective Cohort Study in a Latin American Hospital.

Background: Simultaneous pancreas-kidney transplantation (SPKT) is a complex and demanding procedure with a considerable risk of morbidity and mortality. Advances in surgical techniques and organ preservation have introduced changes in care protocols. Two cohorts of patients receiving SPKT with two different protocols were compared to determine overall survival and pancreatic and renal graft failure-free survival. Methods: This retrospective observational study was conducted in two cohorts of SPKT recipient patients that underwent surgery between 2001 and 2021. Outcomes were compared in transplant patients between 2001 and 2011 (cohort 1; initial protocol) and 2012-2021 (cohort 2; improved protocol). In addition to the temporality, the cohorts were defined by a protocolization of technical aspects and medical management in cohort 2 (improved protocol), compared to a wide variability in the procedures carried out in cohort 1 (initial protocol). Overall survival and pancreatic and renal graft failure-free survival were the primary outcomes. These outcomes were determined using Kaplan-Meier survival analysis and the log-rank test. Results: Fifty-five SPKT were performed during the study period: 32 in cohort 1 and 23 in cohort 2. In the survival analysis, an average of 2546 days (95% CI: 1902-3190) was found in cohort 1, while in cohort 2, it was 2540 days (95% CI: 2100-3204) (p > 0.05). Pancreatic graft failure-free survival had an average of 1705 days (95% CI: 1037-2373) in cohort 1, lower than the average in cohort 2 (2337 days; 95% CI: 1887-2788) (p = 0.016). Similarly, renal graft failure-free survival had an average of 2167 days (95% CI: 1485-2849) in cohort 1, lower than the average in cohort 2 (2583 days; 95% CI: 2159-3006) (p = 0.017). Conclusions: This analysis indicates that pancreatic and renal graft failure-free survival associated with SPKT decreased significantly in cohort 2, with results related to improvements in the treatment protocol implemented in that cohort.

Efficacy of CAD/CAM technology in dental procedures performed by students: A systematic scoping review of randomized clinical trials.

To assess the efficacy of computer-aided design/computer-aided manufacturing (CAD/CAM) in dental procedures performed by dental students. METHODS: A systematic scoping review was performed. MeSH terms and keywords were specified to assess randomized clinical trials (RCTs) in all idioms. RESULTS: Nine RCTs that include 520 students were selected. Two RCTs studied implant placement, and the rest of the trials explored implant impressions, intraoral scans, canal obturation, head positioning errors in panoramic images, deep caries and pulp exposure, diagnosis of temporomandibular disorders, and a tooth for restorations. Considering efficacy, variable results were found. The RCTs that explored implant impressions, deep caries and pulp exposure, and diagnosis of temporomandibular disorders showed better results when CAD/CAM technology was performed by students. Two RCTs that investigated implant placement presented contradictory outcomes; one showed better results when CAD/CAM systems were used while the other described similar results to conventional methods. The remaining RCTs did not find differences with conventional procedures. Considering the time spent during the procedures, two studies showed no differences between groups, while another indicated that the time spent was less for digital impressions (p < 0.001). A continuous decrease in scanning time was also perceived for all groups as skills in intraoral scanning augmented (p = 0.0005). Students indicated an interest in utilizing the CAD/CAM systems and recognized that their abilities were enhanced. CONCLUSIONS: Considering the limitations of this review and the limited number of RCTs evaluated, students recognized that their skills improved using CAD/CAM systems; however, only in some specific procedures greater efficacy and less time spent were observed when this technology was used. Dental students also showed great interest in using these techniques.

A Systematic Review of Randomized Clinical Trials Evaluating the Efficacy of Minimally Invasive Surgery for Soft Tissue Management: Aesthetics, Postoperative Morbidity, and Clinical Results.

Background and Objectives: The necessity for less invasive and patient-friendly surgical therapies guided the development of the "minimally invasive surgical technique" (MIST). The aim of this systematic review was to evaluate the efficacy of MIST for soft tissue management considering aesthetic results, postoperative morbidity, and clinical outcomes. Materials and Methods: Several databases were used to conduct a thorough analysis of the scientific evidence. To investigate randomized clinical trials (RCTs), MeSH terms and keywords were provided. Results: Eleven RCTs were chosen. These experiments included 273 patients. The trials that explored MIST for papilla preservation presented greater efficacy in increasing papillary height (p < 0.05). MIST showed stable clinical outcomes for the management of excessive gingival display and with a flapless technique for single implant placement. Considering the treatment of gingival recessions, some RCTs presented greater root coverage with MIST (p < 0.05), while other trials did not show differences between groups. Regarding aesthetic perception, five RCTs indicated high patient satisfaction with MIST (p < 0.05). Similarly, six RCTs reported that patients in the MIST group presented significantly less post-surgical pain and lower wound healing scores (p < 0.01). Conclusions: It was concluded that using MIST resulted in more clinical studies reporting better clinical outcomes. Considering aesthetic appearance, slightly more than half of the clinical trials also showed improved results with MIST. Likewise, regarding postoperative morbidity, 60% of the clinical trials also described better scores with MIST. All of this indicates that MIST is a good alternative for the management of soft tissues.

ST­segment elevation associated with intraparenchymal hemorrhage: A case report.

The electrocardiogram (ECG) changes in patients with intraparenchymal hemorrhage (IPH) have remained largely elusive and no case reports are currently available in the scientific literature. The medical management of a patient with ST-segment elevation associated with IPH was described in the present study. The case report describes a 78-year-old male patient who presented with ST-segment elevation in V1, V2, V3 and V4 on ECG. Initially, the case was managed therapeutically as an acute myocardial infarction. Later, the patient was transferred to a higher-level hospital, where a new ECG confirmed ST-segment elevation. Simple skull tomography was also performed, which revealed a spontaneous right basal ganglion in the context of an acute cerebrovascular accident of hypertensive origin. A transthoracic ECG was ordered, which revealed an ejection fraction of 65% with type I diastolic dysfunction due to relaxation disorders and without any signs of ischemia, intracavitary masses or thrombi. In addition to the presence of nonspecific ECG findings, clinicians should consider immediate brain computed tomography to confirm intracranial hemorrhage.

Anterior Dislocation of the Tibiofibular Joint: A Case Report.

Dislocation of the proximal tibiofibular joint (PTJ) is a knee injury that occurs infrequently. In this case, the dislocation of the PJT of the right knee was reported with subsequent pain and limitation in range of motion, caused by trauma during the practice of a soccer game. An intense pain was observed in the area where the head of the fibula is located without finding crepitation or deformity. Initially, comparative anteroposterior and lateral X-rays of the knees were requested, showing proximal tibiofibular joint incongruity with anterolateral displacement without evidence of fracture lines. For this reason, it was decided to take a tomography of the right knee that confirmed the presence of anterior dislocation of the proximal tibiofibular joint. Closed reduction under sedation was scheduled.

Primary Headache Approach in the Emergency Departments: A Systematic Scoping Review of Prospective Studies.

This systematic scoping review aims to answer questions related to the main characteristics of primary headache, the need for neuroimaging, and the presence of red flags in these patients. A review of prospective studies including the MEDLINE/PubMed, Scopus, LILACS, and SCIELO databases, as well as the grey literature, was conducted. The methodological quality of the selected investigations was also assessed. Six investigations met the selection criteria. The mean age of people with primary headache was less than 43 years, with ages ranging from 39 to 46 years. Most of the studies reported the presence of nausea/vomiting, between 12% and 60% of the patients studied. To a lesser extent, there was also the presence of intense and moderate pain, loss of consciousness, stiff neck, presence of aura, and photophobia. The most frequent diagnoses were unspecified headache, migraine, and tension headache. The studies did not recommend neuroimaging and no red flags were reported. Primary headache occurred more frequently in women, in those under 46 years of age with a history of migraine and similar episodes. Moreover, the presence of red flags and the need for neuroimaging in patients with primary headaches were not evidenced.

Point­of­care ultrasound for the diagnosis of liver abscess in a patient with HIV in the emergency department: A case report.

A liver abscess is an entity that is rarely observed in the emergency department; therefore, it requires timely diagnosis by the clinicians who support this service. The early diagnosis of a liver abscess is challenging as variable and non-specific symptoms are present; furthermore, symptoms may differ in patients with human immunodeficiency virus (HIV) infection. To date, reports on the presentation of diagnostic ultrasound with point-of-care ultrasonography (PoCUS) are limited. The present case report study describes a patient diagnosed with HIV and the presence of a liver abscess confirmed by PoCUS performed in an emergency department. The patient presented with abdominal pain upon palpation in the right hypochondrium and in the thoracoabdominal area, which became more severe with inspiration. PoCUS revealed a hypodense intrahepatic image observed between segments VII and VI, with internal echoes suggestive of a liver abscess. Moreover, it was decided to perform tomography-guided percutaneous drainage of the liver abscess. Antibiotic treatment with ampicillin/sulbactam and IV metronidazole was also commenced. The patient presented clinical improvement and was discharged on the third day.

Efficacy of three-dimensional models for medical education: A systematic scoping review of randomized clinical trials.

To estimate the efficacy of three-dimensional (3D) models for medical education. METHODS: A systematic scoping review was performed containing diverse databases such as SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS. MeSH terms and keywords were stipulated to explore randomized clinical trials (RCTs) in all languages. Solely RCTs that accomplished the eligibility criteria were admitted. RESULTS: Fifteen RCTs including 1659 medical students were chosen. Five RCTs studied heart models, 3 RCTs explored facial, spinal and bone fractures and the rest of the trials investigated eye, arterial, pelvic, hepatic, chest, skull, and cleft lip and palate models. Regarding the efficacy of 3D models, in terms of learning skills and knowledge gained by medical students, most RCTs reported higher scores. Considering the test-taking times, the results were variable. Two RCTs showed less time for the 3D group, another RCT indicated variable results in the response times of the test depending on the anatomical zone evaluated, while another described that the students in the 3D group were slightly quicker to answer all questions when compared with the traditional group, but without statistical significance. The other 11 experiments did not present results about test-taking times. Most students in all RCTs indicated satisfaction, enjoyment, and interest in utilizing the 3D systems, and recognized that their abilities were enhanced. CONCLUSIONS: Higher efficacy in terms of learning skills and knowledge gained was observed when the 3D systems were used by medical students. Undergraduates also expressed great satisfaction with the use of these technologies. Regarding the test-taking times, the results favored the 3D group.

Antimicrobial resistance in patients with endodontic infections: A systematic scoping review of observational studies.

The aim of this study was to assess the prevalence and proportions of antimicrobial-resistant species in patients with endodontic infections. A systematic scoping review of scientific evidence was accomplished involving different databases. Nine investigations were selected including 651 patients. Enterococcus faecalis was resistant to tetracycline (30%-70%), clindamycin (100%), erythromycin (10%-20%), ampicillin (9%) and azithromycin (60%). On the contrary, Prevotella spp., Fusobacterium spp., Peptostreptococcus spp. and Streptococcus spp. were resistant to penicillin, tetracycline, doxycycline, ciprofloxacin, amoxicillin, erythromycin, metronidazole and clindamycin in different proportions. Fusobacterium nucleatum showed high resistance to amoxicillin, amoxicillin plus clavulanate and erythromycin. Prevotella oralis presented a predisposition to augment its resistance to clindamycin over time. Tanerella forsythia exhibited resistance to ciprofloxacin and rifampicin. Lactococcus lactis presented robust resistance to cephalosporins, metronidazole, penicillin, amoxicillin and amoxicillin-clavulanic acid. It was observed high levels of resistance to antimicrobials that have been utilised in the local and systemic treatment of oral cavity infections.

Accuracy of point­of­care ultrasonography in the diagnosis of necrotizing fasciitis: A case report.

Necrotizing fasciitis is a serious infectious condition that may compromise the patient's life. In the present case study, a 42-year-old male patient was reported. The condition manifested as the presence of subjective fever, general malaise, myalgia, non-productive cough, dysphagia and neck pain ~1 week prior to hospital admission. Vascular dissection was considered as the initial diagnostic suspicion, and thus, angiotomography of neck vessels was performed, ruling out aortic and neck vessel dissection. Radiology indicated negativity for aortic syndrome and cervical vascular disease, but the presence of cervical-mediastinal edema, lamellar fluid between muscular and fatty planes and posterior pulmonary atelectasis, absence of pleural fluid or consolidations, and tonsillar hypertrophy without abscesses. Due to the rapid evolution of the condition, the presence of dyspnea with the need for supplemental oxygen, and the disproportion between the intensity of the pain described by the patient and the external findings observed, the presence of necrotizing fasciitis was considered. Point-of-care ultrasonography was performed, indicating a cobblestone pattern of the subcutaneous cellular tissue, with diffuse thickening of the anterior cervical fascia and increased echogenicity with soft tissue edema posterior to the fascia. Magnetic resonance imaging confirmed the inflammatory findings in the fascia and other cervical soft tissues, without exhibiting any signs of necrosis, but with the presence of abscesses in the visceral and carotid space.

Ischemic Stroke Secondary to a Stab Wound to the Neck in a Young Adult.

Vertebral artery dissection is a common cause of stroke in young adults without predisposing risk factors for cerebrovascular disease. We describe the case of a 28-year-old patient who presented with an ischemic stroke secondary to a stab wound to the neck that affected the vertebral artery. A physical examination revealed neurological deterioration (Glasgow 8/15), a sutured neck wound, no palpable hematoma, no thrills, and no active bleeding. A computed tomography angiography revealed a left vertebral artery arteriovenous fistula with a component of a pseudoaneurysm, for which a neurointerventional consultation was carried out. Due to neurological compromise, the airway was secured, and because the case involved a posterior fossa infarction with compression of the fourth ventricle and obstructive secondary hydrocephalus, an external ventricular shunt was inserted by neurosurgery. A fistula occlusion was performed with five Axium coils and a vial of Squid 12; the vertebral artery was catheterized, and a craniotomy was performed to manage hydrocephalus with a 12-mm H2O collecting system. The patient was discharged on the tenth day after admission with sequelae of left hemiparesis (predominantly brachial) and no other deficits. There was no hemorrhagic transformation on the control computed tomography scans and no further complications.

Kounis Syndrome Secondary to Laxative Administration.

Kounis syndrome (KS) is defined as an acute coronary syndrome triggered by the release of inflammatory mediators after an allergic attack. It usually occurs secondary to allergic injuries from foods, medications, and insect bites. However, there are no known reports of KS secondary to the intake of laxatives. This article reports the case of a 43-year-old woman who, after ingesting a dose of sodium phosphate monobasic/sodium phosphate dibasic, presented a maculopapular rash on the trunk and extremities. The electrocardiogram showed ST depression in V4-V5-V6 and signs of prolonged QTc; troponin I uptake was positive. Due to presumed myocardial injury and high suspicion of coronary disease, coronary angiography was requested, which showed epicardial coronary arteries, without angiographically significant stenosis, thus confirming the presence of KS secondary to the ingestion of a laxative.

Remolinos mesentéricos en la angiotomografía de paciente con hernia de Petersen y aparente trombosis mesentérica / Mesenteric swirl on angiotomography of a patient with Petersen's hernia and apparent mesenteric thrombosis

RESUMEN Introducción: Las imágenes diagnósticas son fundamentales para diagnosticar la trombosis de la vena mesentérica y la hernia de Petersen. Objetivo: Describir el tratamiento de una paciente que en angiotomografía presentó aparente trombosis de la vena mesentérica y hernia de Petersen. Caso clínico: Una paciente consultó por dolor abdominal tipo cólico, de predominio en epigastrio, irradiado a región dorsal. Por el cuadro clínico sugestivo de emergencia vascular se solicitó inmediatamente angiotomografía de vasos del tórax y abdomen. Las imágenes revelaron permeabilidad de la arteria mesentérica superior en su origen y en tercio proximal, se aprecia un giro de vasos (signo de remolino) a aproximadamente 7 cm de su origen, con aparente oclusión completa, por trombosis. En el mismo sitio donde se evidenció el giro de vasos, se apreció aparente inicio de trombosis de la vena mesentérica superior. Se realizó procedimiento quirúrgico en el cual se encontró espacio de Petersen y herniación de todo el intestino delgado a través de dicho espacio. La laparotomía evidenció que la paciente no cursó con trombosis, sino que era un efecto dado por la imagen y el hallazgo que se veía era secundario a la hernia de Petersen. Conclusiones: La presencia del signo de remolino en una angiotomografía es muy importante pero no definitiva en el diagnóstico de la hernia de Petersen.

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.