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GASTROINTESTINAL IMAGING Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 2  |  Page : 189-190
Signs : "whirlpool sign" in midgut volvulus


Department of Radiodiagnosis, Govt. Medical College, Nagpur, India

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Keywords: Signs, Whirlpool, Midgut volvulus

How to cite this article:
Taori K, Mahajan S, Dhomne S, Manikpure S. Signs : "whirlpool sign" in midgut volvulus. Indian J Radiol Imaging 2004;14:189-90

How to cite this URL:
Taori K, Mahajan S, Dhomne S, Manikpure S. Signs : "whirlpool sign" in midgut volvulus. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Jul 21];14:189-90. Available from: http://www.ijri.org/text.asp?2004/14/2/189/28585

   Introduction Top


A midline abdominal mass of whirling small intestinal loops and the whirlpool pattern of the superior mesenteric vein around the superior mesenteric artery in midgut volvulus is termed as the "Whirlpool Sign". We would like to illustrate this with an example.


   Case Report Top


A sixteen year young female presented with distension of the abdomen, bilious vomiting and a clinical diagnosis of intestinal obstruction. Plain radiographs done showed signs of upper gastrointestinal obstruction. US (ultrasound) transverse section at the level of SMA showed SMV coiled around the SMA in clockwise rotation - whirlpool sign" along with a heterogeneous mass surrounding the SMA - mesentery and gut. CT scan also showed the "whirlpool sign" and confirmed the US findings. Adiagnosis of midgut mal-rotation associated with volvulus was made which was confirmed on surgery.


   Discussion Top


Midgut Volvulus is an abdominal surgical emergency occurring mainly in the neonatal period but sometimes presenting late [1 ]. Midgut volvulus is usually secondary to a clockwise rotation around the axis of the superior mesenteric artery. Volvulus due to midgut malrotation can be detected by "whirlpool" sign on US and CT [2]

The dilated duodenum is not a specific sign of midgut volvulus and may be absent in a vomiting patient [3]. Pracros et al have suggested that volvulus due to midgut malrotation can be detected by the "whirlpool" US sign[2]. The sign appeared specific for midgut volvulus since it was not observed in other complications of midgut malrotation, such as isolated Ladd's bands [2]. Ultrasonography may reveal a midline abdominal mass with dilated collateral mesenteric vessels and whirling small intestinal loops, shown as sonolucent layers. The sonographic "whirlpool" pattern of the superior mesenteric vein and mesentery around the superior mesenteric artery can be detected in most of the patients with midgut volvulus, and is best seen using Color Doppler [2]. Similar radiological findings can also be seen on CT.

In 1992, Dufour et al examined over 300 patients with ultrasonography. Finding the superior mesenteric vein (SMV) to the left of the SMA was highly suggestive of malrotation, while an anterior SMV was questionable [4].

If volvulus has developed as a consequence of intestinal malrotation, the obstruction typically is complete, and compromise to the blood supply of the midgut has started (because of the twisting of the mesentery at the narrow pedicle of the superior mesenteric artery). Because SMA territory includes the segment from the proximal duodenum to the mid transverse colon, the entire midgut may become necrotic and nonviable if the volvulus is not corrected in time. Necrosis of the entire midgut is incompatible with life [5].

So we would like to conclude that midgut volvulus is a serious complication and surgical emergency that is frequently seen in neonates and young adults. The radiologist plays a major role in the diagnosis of this condition. When radiographic findings are subtle or equivocal, CT frequently allows identification of the disease process. Imaging findings in cases of midgut malrotation, is so specific that in the appropriate clinical setting, familiarity with the US and CT findings of "Whirlpool sign may establish the specific preoperative diagnosis before the occurrence of serious and fatal complications.

 
   References Top

1.Spigland N, Brandt ML, Yazbeck S. Malrotation presenting beyond the neonatal period. J Pediatr Surg 1990; 25: 1139.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Pracros JP, Sann L, Genin G, et al. Ultrasound diagnose of midgut volvulus: the "whirlpool" sign. Pediat Radiol 1992; 22: 18-20.  Back to cited text no. 2  [PUBMED]  
3.Hayden CK, Boulden TF, Swischuk LE, Lobe TE. Sonographic diagnosis of duodenal obstruction with midgut volvulus. AJR 1984; 143:9.  Back to cited text no. 3    
4.Dufour D, Delaet MH, Dassonville M: Midgut malrotation the reliability of sonographic diagnosis. Pediatr Radiol 1992; 22(1): 21-3.  Back to cited text no. 4    
5.S. Magu, K.N. Rattan, N. Sharma: Whirlpool Sign -Midgut: Volvulus (An US Diagnosis). Ind J Radiol Imag 2001 11:4:205-206.  Back to cited text no. 5    

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Correspondence Address:
K Taori
Department of Radiodiagnosis, Govt. Medical College, Nagpur
India
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Source of Support: None, Conflict of Interest: None


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    Introduction
    Case Report
    Discussion
    References
    Article Figures

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