Small bowel volvulus is a causative factor for strangulated ileus and necessitates a rapid surgical correction.This disease, however, presents difficulty in diagnosis by physical examination and plain abdominal X-ray examination. Delayed surgical intervention is not uncommon.
We have experienced a case of secondary small bowel volvulus in which preoperative diagnosis was made by whirl sign on CT, allowing rapid surgical intervention.
A 66-year-old woman was admitted to the hospital because of progressive paraumbilical pain lasting for 16 hours. There was a previous history of undergoing extended distal gastrectomy for gastric ulcer 20 years earlier. Physical examination revealed a bowel like mass with tenderness in the right paraumbilical region. Initial laboratory tests were within normal limits. Abdominal CT demonstrated whirl sign indicative of midget volvulus, The patient was diagnosed as having small bowel volvulus and underwent emergency operation. During surgery it was found that the volvulus of the terminal ileum was secondary to intraabdominal adhesions without necrotized lesion in the intestine.