Sigmoid volvulus - whirlpool sign
Severe generalized colicky abdominal pain of 2 hours duration.
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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.
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.