{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:03:47Z","timestamp":1790892227825,"version":"4.1.0"},"reference-count":33,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:p>The mesenteric whirl sign on computed tomography (CT) should be approached as a surgical decision signal for potentially bowel-threatening mechanical disease rather than as an isolated radiologic label. Not every whirl pattern represents fixed active volvulus; however, underestimating a true whirl sign can delay recognition of closed-loop obstruction, internal hernia, strangulation, bowel necrosis, perforation, sepsis, and death. This review reframes the sign around the management question most relevant to general surgeons: when should imaging evidence of mesenteric rotation alter care before frank ischemia is visible? We review the differential diagnosis of actionable whirl-pattern disease, including small-bowel volvulus, adhesive closed-loop obstruction and band disease, post-Roux-en-Y gastric bypass internal hernia, transmesenteric and paraduodenal hernias, cecal volvulus, sigmoid volvulus, malrotation-associated midgut volvulus, and other torsion syndromes with vascular compromise. We then organize CT risk features into mechanical and ischemic constellations and propose a practical bedside assessment incorporating serial abdominal examination, systemic inflammatory or septic physiology, complete blood count, lactate, metabolic and acid-base status, peritonitis, tachycardia, persistent vomiting, progressive distention, and overall trajectory. A non-confirmatory exploration is often recoverable; missed bowel-threatening mechanical disease may not be.<\/jats:p>","DOI":"10.1177\/00031348261494135","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:59:49Z","timestamp":1790776789000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Mesenteric Whirl Sign: A Surgical Decision Signal for Bowel-Threatening Mechanical Disease"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0308-4915","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"Garc\u00eda-L\u00f3pez","sequence":"first","affiliation":[{"name":"Universidad Aut\u00f3noma de Nuevo Le\u00f3n"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9709-3751","authenticated-orcid":false,"given":"Luis Felipe","family":"Manzano 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