Cecal Volvulus Diagnosed with a Whirl Sign: A Case Report

Cecal volvulus is responsible for about 1.9% of all colonic obstructions in the United States.1 Common physical exam findings are abdominal distension with generalized abdominal tenderness; however, the presentation can vary.2 A 64-year-old female presented with right upper quadrant abdominal pain associated with nausea and vomiting. On physical examination, Murphy sign was present. A comprehensive ultrasound was negative for cholecystitis. The diagnosis of cecal volvulus was made using computed tomography (CT), which demonstrated a “whirl sign.” Surgery was consulted and emergently took the patient to the OR for a detorsion and right hemicolectomy. The patient made a full recovery with return of normal bowel function on post-op day 3. Additionally, no further adverse effects reported on follow-up. This case report further emphasizes the importance of maintaining a wide differential for patients with abdominal pain regardless of the location in the abdomen. In addition, when suspecting a bowel obstruction, the “whirl sign” is a visual diagnosis suggestive of a cecal volvulus requiring emergent surgical consultation. TOPICS: Cecal volvulus, abdominal pain, whirl sign, right upper quadrant, CT.