CT of Acute Abdomen

Epigastric Pain series 5 EXPERT COURSE Answer [EE Case 25]

Volvulus of small bowel with no necrosis.






A large quantity of ascites (reference mark) of Fig.1-Fig.6 suggests something critical is developing, and it is important to investigate thoroughly what is happening. Because it is arterial phase, SMV is not yet contrast-enhanced. SMA branch (white arrowhead) of Fig.7-Fig.12 turns in an anti-clock direction, and it is called "whirl sign" which describes the swirling appearance of bowel and mesentery twisted around the SMA axis. It is important finding meaning volvulus of intestine. a of Fig.5 rotates in 360 degrees reaching b of Fig.7 and Fig.8, as for b, 360 degrees another rotation. An accurate diagnosis was made based on the CT scan findings and the operation was undertaken. There was adhesion between mesentery and the abdominal wall, and small intestine twisted centering on it, but there was no bowel necrosis and distortion with adhesiotomy was performed.











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