Whirlpool sign of sigmoid volvulus

Case contributed by Dr Shihab Ahmed Mahdi

Presentation

Severe generalized abdominal pain of 2 hours duration. The pain was colicky in nature throughout the abdomen, with occasional burning sensation in the epigastric region and pain radiating to the back. 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. Abdomen was mildly distended with generalized tenderness and guarding mainly on the the left side of the abdomen. Initial management with IV fluids and analgesia.

Patient Data

Age: 47
Gender: Male
CT

CT abdomen

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

Case Discussion

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
Case created: 7th Apr 2013
Last edited: 10th Jul 2016
Inclusion in quiz mode: Excluded

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