Whirl Sign and Midgut Volvulus: An Unusual Cause of an Acute Abdomen in an Adult Patient

Abstract

We report the case of a 50-year-old lady who presented to the emergency department complaining of a two-day history of colicky right upper quadrant (RUQ) pain, which radiated through to her back, associated with nausea, anorexia, and two episodes of vomiting that day. She was found to be tender in the RUQ. Her blood tests were notable for an elevated white cell count. Initial impression was of acute cholecystitis. Ultrasound of her abdomen did not identify any features of acute cholecystitis; however, a large volume of free fluid was identified within the abdomen. CT of the abdomen/pelvis was obtained which identified dilated loops of small bowel, interloop ascites, and a whirl sign highly suggestive of midgut volvulus. During laparoscopy, the midgut volvulus was found to have resolved. No cause for the volvulus could be identified, and the patient was discharged home well on postoperative day two.

Small Bowel Volvulus In Adult: A Review Of Literature

“…The terminology volvulus evolved from the Latin word "volvere" which means "to roll or twist" [8] - [10]. The first description of volvulus was mentioned in papyrus Ebers, dated 1550 BC as a "natural course of twisting of a segment of the alimentary tract led to either spontaneous resolution or rotting of the intestines".…”

“…SBV is a condition where the bowel loops coiled around the axis of its own mesentery [4]. Midgut volvulus occurs when the bowel loop twist more than 180° around its own mesenteric vascular pedicle [8]. This coiling can lead to partial or complete mechanical obstruction [11] with or without the interference of its blood circulation [12].…”

“…According to the statistics, PSBV is commonly seen in children and young adults, whereas SSBV is prevalent mainly in adults [14]. Literature has reported that SSBV is prevalent much higher in the elderly group ranging from 60 to 90 years [4], [8], [14], [22].…”

“…Because of its vague and nonspecific nature, it mimics irritable bowel syndrome, peptic ulcer disease, pancreatic disease, Biliary disease, psychiatric disease [2], [9], acute appendicitis [8].…”

“…PAR can demonstrate nonspecific signs of SBO i.e. dilated SB loops with air-fluid level and occasionally pneumatosis intestinalis and thumbprinting impression which are the signs suggestive of intestinal ischemia [8].…”