Visual Diagnosis in Emergency Medicine| Volume 46, ISSUE 3, P383-384, March 2014

Typical Whirl Sign in Sigmoid Volvulus

      A 70-year-old man without previous medical or surgical history came to our Emergency Department (ED) complaining of a sudden onset of left abdominal pain for hours. The character of pain was constant. He had a similar episode previously but it was of short duration. He denied any vomiting, diarrhea, constipation, or dysuria. On arrival, physical examination revealed diffuse left abdominal tenderness without muscle guarding, and he had hyperactive bowel sounds. Results of laboratory data revealed normal white blood cell count (7800/μL) and mild hypokalemia (2.8 mEq/L). There was neither hematuria nor pyuria in the urinalysis. A plain abdominal x-ray study was notable for an inverted U-shaped colonic gas pattern (Figure 1, arrows) and the absence of rectal gas. In the abdominal computed tomography (CT) scan, we saw an impressive picture of a typical whirl sign, a twisting loop of intestine and its mesentery in a whirl-like pattern (Figure 2, arrows) with an enlarged sigmoid. Sigmoid volvulus was diagnosed quickly and the obstruction was successfully relieved after colonoscopy. After resolution of the obstruction, the patient was discharged against medical advice from the ED.
      Figure thumbnail gr1
      Figure 1In this plain abdominal x-ray study, abnormal inverted U-shaped colon gas (arrows) and an absence of rectal gas were noted.
      Figure thumbnail gr2
      Figure 2An impressive picture of typical whirl sign, a twisting loop of intestine and its mesentery in a whirl-like pattern (arrows), was seen in the computed tomography scan.
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