Presentation
Abdominal distension with pain, watery diarrhea and postural hypotension.
Patient Data
An acutely obstructed sigmoid colon is seen with twisting of the distal sigmoid. Swelling of the mesenteric vessels at the transition site in the left para midline mid abdomen shows a probable whirlpool sign. Some slight inflammatory changes are adjacent to the abnormally configured mesenteric vessels. The topogram shows the coffee bean sign.
There is small volume pelvic free fluid with no pneumoperitoneum, pneumatosis or portal venous gas. The rectum is filled with gas and feces.
There is also a small calyceal calculus in the lower pole of the left kidney without hydronephrosis.
Case Discussion
The patient had a history of sigmoid volvulus secondary to fecal loading that was managed non-operatively the month prior.
The CT abdominal images demonstrate a whirlpool sign, which is best appreciated on coronal slices. The topogram performed shows a coffee bean sign. Both are characteristic of sigmoid volvulus 1.
The whirlpool sign can also refer to the 'whirl' effect in testicular and ovarian torsions.
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