Quadruple (1440 degrees) intestinal volvulus

Abstract

Key clinical message: A whirl sign on contrast-enhanced abdominal CT scan is indicative of intestine twisted around the mesenteric vessels, and is observed in cases of strangulated obstruction, signaling compromised intestinal circulation. In cases of intestinal volvulus, surgery is necessary to untwist the affected bowel, and resection is necessary if necrosis is present.

Abstract: A 31-year-old Japanese man presented with acute lower abdominal pain and vomiting. Contrast-enhanced abdominal computed tomography (CT) revealed a 1440-degree clockwise torsion of superior mesenteric artery and a whirl sign. Intestinal volvulus in adulthood with a background of malrotation is extremely rare. Contrast-enhanced CT is effective for diagnosis.

Keywords: abdominal contrast‐enhanced computed tomography; intestinal volvulus; malrotation; whirl sign.

FIGURE 1

(A–F) Contrast‐enhanced abdominal computed tomography (CT) revealed a 1440‐degree clockwise torsion of the superior mesenteric artery, with surrounding soft tissue involvement, and a whirl sign.

FIGURE 2

The duodenojejunal junction was displaced rightward, with a subhepatic cecum, and the transverse colon was dorsal to the superior mesenteric artery.