Sigmoid volvulus - whirlpool sign

Case contributed by Dr Shihab Ahmed Mahdi

Presentation

Severe generalized colicky abdominal pain of 2 hours duration.

Patient Data

Age: 45 years
Gender: Male
CT

CT abdomen

A couple of selected images from a CT scan of the abdomen shows a grossly distended sigmoid colon (bean-shaped), with torsion of the sigmoid mesentery. No evidence of bowel perforation. 

Case Discussion

The patient presented with colicky pain throughout the abdomen radiating to the back, with occasional burning sensation in the epigastric region. There was constipation with one episode of vomiting. This presentation was the second such episode; the patient had the same pain 3 years before and was treated conservatively with IV fluids.

On examination: BP:145/84, PR:113, SPO2: 100%, Pain score: 10/10. The abdomen was mildly distended with generalized tenderness and guarding mainly on the left side of the abdomen.
Initial management with IV fluids and analgesia. 

Clinical and imaging features compatible with sigmoid volvulus. A specific CT sign for volvulus is the whirlpool sign, which has been described in volvulus of the midgut, cecum, and sigmoid colon.

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Case information

rID: 22563
Published: 7th Apr 2013
Last edited: 29th Dec 2019
Inclusion in quiz mode: Excluded

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