Presentation
History of fallopian tube cancer and had de-bulking. Now she presents with worsening abdominal pain and distension.
Patient Data
Age: 65 years
Gender: Female
Axial renal excretory phase
CT demonstrates a small bowel obstruction due to a midgut volvulus (note the whirlpool sign of the SMA / SMV).
Case Discussion
CT with intravenous contrast of the abdomen demonstrates swirling of the mesenteric root (whirlpool sign) with dilated loops of small bowel. The mesenteric volvulus is highly concerning for vascular compromise necessitating surgical intervention.
Differential considerations
- closed-loop bowel obstruction
- transmesenteric hernia with associated volvulus
Note that these may be radiographically indistinguishable.
Diagnosis
Transmesenteric defect was noted on laparotomy. Appropriate bowel decompression and a surgical correction were performed.
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