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Case Report: It's a Small Whirl Afterall
Lisa M Schwartz1, Ryan M Perdomo1, Jason An1
1University of California Riverside, Department of Emergency Medicine, Riverside, CA.
Journal of Education & Teaching in Emergency Medicine
|July 24, 2023
Summary
The whirl sign on CT scans indicates small bowel obstruction (SBO) and raises the risk of bowel ischemia. Early surgical consultation for SBO with a whirl sign is crucial to improve patient outcomes.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Oncology
Background:
- Small bowel obstruction (SBO) is a common surgical emergency.
- The whirl sign on computed tomography (CT) imaging is a specific finding associated with SBO.
- Gastric bypass surgery is a risk factor for internal hernias leading to SBO.
Purpose of the Study:
- To highlight the significance of the whirl sign in diagnosing SBO.
- To emphasize the association between the whirl sign and bowel ischemia.
- To advocate for prompt surgical consultation in cases of SBO with a whirl sign.
Main Methods:
- Case report of a 40-year-old woman with SBO.
- Review of CT imaging findings, specifically the whirl sign.
- Analysis of clinical presentation, diagnosis, and patient outcome.
Main Results:
- CT revealed a whirl sign pattern consistent with SBO.
- Despite prompt diagnosis, the patient developed ischemic bowel.
- The patient required multiple bowel resections and had a prolonged hospital course.
Conclusions:
- The whirl sign on CT is a critical indicator of potential bowel ischemia in SBO.
- Emergency department providers must recognize the whirl sign.
- Urgent surgical consultation is recommended for patients with SBO and a whirl sign to reduce morbidity and mortality.
