“Whirl Sign” in Mesentero-Axial Cecal Volvulus

Excerpt

A 59-year-old woman presented with a 3-day history of cramping abdominal pain, obstipation, nausea, and vomiting. Her medical history revealed neither tumors of the gastrointestinal tract nor previous surgery but a chronic constipation treated with laxatives. Vital signs were normal and she had no fever. Clinical examination showed an asymmetric distended abdomen most pronounced in the upper left quadrant without peritoneal signs, no hernias were noted, and at the digital rectal examination, no blood or stool was detected. Blood tests, including white blood cell count, C-reactive protein, and lactates, were normal except for a slight alteration of the electrolytes level. A nasogastric tube was inserted and intravenous fluids were administered. The computed tomography (CT) scan of the abdomen showed a dilated cecum (maximum diameter 10 cm) with air-fluid levels in the upper left quadrant (Fig. 1); left descending colon and sigma were identified, whereas the stomach was displaced upwards (Fig. 2). The hypothesis of a mesentero-axial cecal volvulus (loop type) was suggested by the identification of a distended ectopic cecum and whirl sign (Fig. 3). Initially, the volvulus was surgically treated by laparoscopy identifying the twisted point (Fig. 3) and sectioning the adhesions; at the same time, no impairment of bowel viability was detected. Then, a midline laparotomy was performed because of ileocecal distension in order to allow cecopexy. The postoperative course was uneventful with discharge on day 4.

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