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Case Report: It's a Small Whirl Afterall.

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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.

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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.