Case Report: It’s a Small Whirl Afterall

Recognition of the whirl sign on computed tomography (CT) imaging can improve patient outcomes in those presenting with small bowel obstruction (SBO). In the case highlighted in this report, a 40-year-old woman with a remote history of gastric bypass presented to the emergency department (ED) with four hours of abdominal pain and vomiting. Findings on the initial CT of the abdomen and pelvis were suggestive of SBO with a whirl sign pattern. The whirl sign occurs after the bowel rotates around the mesentery, leading to a visual “whirl” of mesenteric vessels. Unfortunately, despite prompt diagnosis, the patient developed an ischemic bowel and ultimately sustained a prolonged hospital course requiring multiple bowel resections. ED providers should familiarize themselves with the whirl sign because its presence in patients with SBO increases the likelihood of ischemia. These patients should have urgent surgical consultation to decrease overall morbidity and mortality. TOPICS: Whirl sign, small bowel obstruction, gastric bypass, internal hernia.