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.