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Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations.
J Ultrasound Med. 2004 Mar; 23(3):397-401.JU

Abstract

OBJECTIVE

To illustrate cases of midgut volvulus in 7 children, of whom only 2 were neonates, diagnosed initially by sonography using the whirlpool sign, and to emphasize the importance of considering malrotation and midgut volvulus in the differential diagnosis of acute or chronic abdominal pain in those beyond the neonatal period, the usual time of presentation for midgut volvulus.

METHODS

The sonography computer database of a large pediatric hospital was reviewed over a 26-month period for sonographic reports that contained the key words midgut volvulus and whirlpool sign. From November 1999 until January 2002, 7 patients had a sonographic diagnosis of midgut volvulus on the basis of the whirlpool sign. Sonographic and surgical records of these patients were reviewed retrospectively. In addition, the department computer database of all contrast-enhanced upper gastrointestinal examinations performed over the same period was searched using the key words midgut volvulus, and an additional 2 cases of midgut volvulus were found, neither of which had undergone a prior or subsequent sonographic study.

RESULTS

Seven patients, ranging in age from 1 day to 5 1/2 years were found to have the whirlpool sign on sonography performed for acute abdominal symptoms, including projectile nonbilious emesis, colicky abdominal pain with suspicion of intussusception, palpable abdominal masses, right lower quadrant abdominal pain with suspected appendicitis, and chronic diarrhea. Six of the 7 cases of midgut volvulus were confirmed with upper gastrointestinal examinations. One patient was taken directly to surgery on the basis of the sonographic findings alone. One patient had subsequent computed tomography of the abdomen for continued suspicion of an abdominal mass. All 7 cases were confirmed as midgut volvulus at surgery.

CONCLUSIONS

The sonographic whirlpool sign is a valid and highly sensitive sign for the diagnosis of midgut volvulus secondary to malrotation, and sonographers should be aware that it frequently occurs beyond the neonatal period with symptoms other than bilious emesis.

Authors+Show Affiliations

Department of Radiology, Baylor College of Medicine, Houston, Texas, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15055787

Citation

Patino, Maria Olga, and Martha M. Munden. "Utility of the Sonographic Whirlpool Sign in Diagnosing Midgut Volvulus in Patients With Atypical Clinical Presentations." Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine, vol. 23, no. 3, 2004, pp. 397-401.
Patino MO, Munden MM. Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. J Ultrasound Med. 2004;23(3):397-401.
Patino, M. O., & Munden, M. M. (2004). Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine, 23(3), 397-401.
Patino MO, Munden MM. Utility of the Sonographic Whirlpool Sign in Diagnosing Midgut Volvulus in Patients With Atypical Clinical Presentations. J Ultrasound Med. 2004;23(3):397-401. PubMed PMID: 15055787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. AU - Patino,Maria Olga, AU - Munden,Martha M, PY - 2004/4/2/pubmed PY - 2004/4/24/medline PY - 2004/4/2/entrez SP - 397 EP - 401 JF - Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine JO - J Ultrasound Med VL - 23 IS - 3 N2 - OBJECTIVE: To illustrate cases of midgut volvulus in 7 children, of whom only 2 were neonates, diagnosed initially by sonography using the whirlpool sign, and to emphasize the importance of considering malrotation and midgut volvulus in the differential diagnosis of acute or chronic abdominal pain in those beyond the neonatal period, the usual time of presentation for midgut volvulus. METHODS: The sonography computer database of a large pediatric hospital was reviewed over a 26-month period for sonographic reports that contained the key words midgut volvulus and whirlpool sign. From November 1999 until January 2002, 7 patients had a sonographic diagnosis of midgut volvulus on the basis of the whirlpool sign. Sonographic and surgical records of these patients were reviewed retrospectively. In addition, the department computer database of all contrast-enhanced upper gastrointestinal examinations performed over the same period was searched using the key words midgut volvulus, and an additional 2 cases of midgut volvulus were found, neither of which had undergone a prior or subsequent sonographic study. RESULTS: Seven patients, ranging in age from 1 day to 5 1/2 years were found to have the whirlpool sign on sonography performed for acute abdominal symptoms, including projectile nonbilious emesis, colicky abdominal pain with suspicion of intussusception, palpable abdominal masses, right lower quadrant abdominal pain with suspected appendicitis, and chronic diarrhea. Six of the 7 cases of midgut volvulus were confirmed with upper gastrointestinal examinations. One patient was taken directly to surgery on the basis of the sonographic findings alone. One patient had subsequent computed tomography of the abdomen for continued suspicion of an abdominal mass. All 7 cases were confirmed as midgut volvulus at surgery. CONCLUSIONS: The sonographic whirlpool sign is a valid and highly sensitive sign for the diagnosis of midgut volvulus secondary to malrotation, and sonographers should be aware that it frequently occurs beyond the neonatal period with symptoms other than bilious emesis. SN - 0278-4297 UR - https://www.unboundmedicine.com/medline/citation/15055787/Utility_of_the_sonographic_whirlpool_sign_in_diagnosing_midgut_volvulus_in_patients_with_atypical_clinical_presentations_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0278-4297&date=2004&volume=23&issue=3&spage=397 DB - PRIME DP - Unbound Medicine ER -