Thus, volvulus continues to be the diagnosis of exclusion in the presence of the whirl sign, even in such patients. In conclusion, the whirl sign is highly suggestive of intestinal volvulus and should raise suspicion for complicated closedbowel obstruction.
Sigmoid volvulus showing a" whirl sign" on computed tomography Paolo Rossi, 1 Pietro Tasellari, 1 Luca Mariotti, 1 Evoli Luca Pio, 1 Nidal Abu Qweider, 1 Emanuela Elia, 1 Patrizia Ricci, 1 Saverio Valiani, 1 and Annibale Donini 1 Some reports have described CT findings specific to volvulus such as the whirl sign, demonstrated in the case of midgut volvulus [13, 15, 16, 17, sigmoid volvulus [18, and cecal volvulus [19, or multiple dilated intestinal loops with edematous mesenteric folds converging radially toward the site of torsion, described in the diagnosis 228 a bFig.
1 The classical sign of acute sigmoid volvulus is the coffee bean sign. Abdominal Computed Tomography (CT) usually reveals a dilated colon with an airfluid level and Figure 1.
AD, Previous sigmoid volvulus treated with endoscopic detorsion. E, Radiologic view showing coffee bean sign. F, Endoscopic treatment of sigmoid volvulus with water immersion technique and guidewire.
Notice the whirl sign. G, ERCP cannula and guidewire across the volvulus for endoscopic decompression and detorsion. H, After endoscopic detorsion of sigmoid volvulus. The" whirl sign"was first described by Fisher, as suggesting volvulus of the small bowel, and it was considered that this sign represents the superior mesenteric artery at the centre surrounded by bowel loops. In a patient with sigmoid volvulus, the whirl sign is caused by tightly twisted bowel and mesentery.
Sigmoid volvulus is a rare condition. A high incidence has been reported in debilitated, or chronically constipated patients. It is important to recognize this condition early and then initiate prompt treatment. Endoscopic treatment has a high perforation risk. The" whirl sign"was first described Sigmoid volvulus is a cause of large bowel obstruction and occurs when the sigmoid colon twists on its mesentery, the sigmoid mesocolon.
Abdominal radiographs will show a large, whirl sign: twisting of the mesentery and mesenteric vessels; volvulus of the caecum, also cecal volvulus; sigmoid colon volvulus (sigmoid volvulus) volvulus of the transverse colon; volvulus of the splenic flexure, the rarest; gastric volvulus; ileosigmoid knotting; Diagnosis.
After taking a thorough history, the diagnosis of colonic volvulus is usually easily included in the differential diagnosis. The whirl sign is well recognized as a sign of volvulus of various parts of the gastrointestinal tract, but its sensitivity for sigmoid volvulus has not been evaluated. In our series, a whirl sign was present in only 12 of 21 cases (57), which indicates the need for additional imaging signs of sigmoid volvulus.
The" whirl sign"was first described by Fisher, as suggesting volvulus of the small bowel, and it was considered that this sign represents the superior mesenteric artery at the centre surrounded by bowel loops. In a patient with sigmoid volvulus, the whirl sign is caused by tightly twisted bowel and mesentery. CT Abdomen showing Sigmoid Volvulus with Steel pan pattern.
Download highres image; Download fullsize image; CT scan findings of sigmoid volvulus include the whirl sign, which represents tension on the tightly twisted mesocolon by the afferent and efferent limbs of the dilated colon, but the classic appearance may be absent in up to Whirl sign: pathognomonic for volvulus Specific features of sigmoidcecal volvulus are similar to those seen in xrays Demonstrates bowel Jan 05, 2016 Other forms of largebowel obstruction, especially those due to sigmoid colon carcinoma, pseudoobstruction, cecal volvulus, and an ileosigmoid knot, may mimic or be confused with a sigmoid volvulus.
At times, emphysematous cystitis and a giant sigmoid diverticulum may also mimic a sigmoid volvulus. The whirlpool sign of the mesentery, also known as the whirl sign, is seen when the bowel rotates around its mesentery leading to whirls of the mesenteric vessels. Terminology. The term whirlpool sign is used in other contexts: see whirlpool sign (disambiguation).
Radiographic features. It is seen in a number of settings: malrotation complicated by midgut volvulus