Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus

Introduction: Adult intestinal malrotation with midgut volvulus is rare and most often diagnosed on abdominal imaging. Once the diagnosis is made, prompt surgical intervention is necessary. A finding suggestive of malrotation with midgut volvulus on abdominal imaging is the “whirlpool” sign where th...

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Autores principales:	Michael Fogam, Natasha Leigh, Trent She
Formato:	article
Lenguaje:	EN
Publicado:	eScholarship Publishing, University of California 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/1e2870346e1545a5ba03cafac1b96808
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spelling	oai:doaj.org-article:1e2870346e1545a5ba03cafac1b968082021-11-23T20:02:52ZWhirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus2474-252X10.5811/cpcem.2021.9.52682https://doaj.org/article/1e2870346e1545a5ba03cafac1b968082021-11-01T00:00:00Zhttps://escholarship.org/uc/item/2z8583tchttps://doaj.org/toc/2474-252XIntroduction: Adult intestinal malrotation with midgut volvulus is rare and most often diagnosed on abdominal imaging. Once the diagnosis is made, prompt surgical intervention is necessary. A finding suggestive of malrotation with midgut volvulus on abdominal imaging is the “whirlpool” sign where the superior mesenteric vein and superior mesenteric artery twist at the root of the abdominal mesentery. This sign was once thought to be pathognomonic, but recent studies have shown that it can be seen in asymptomatic patients. Case Report: A 20-year-old female presented to our emergency department with diffuse abdominal pain. Computed tomography demonstrated the “whirlpool” sign with a concern for malrotation with midgut volvulus. Surgical consultation was obtained and the patient was rushed to the operating room for an exploratory laparotomy. Normal mesenteric attachments were seen and no significant pathology was identified during the laparotomy. The patient was eventually diagnosed with gastritis and discharged in stable condition. Conclusion: Emergency physicians and surgeons alike should be cautious in confirming malrotation with midgut volvulus solely due to the “whirlpool” sign on abdominal imaging. Premature diagnostic closure can lead to unnecessary procedures and interventions for patients as in the case we report here.Michael FogamNatasha LeighTrent SheeScholarship Publishing, University of CaliforniaarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENClinical Practice and Cases in Emergency Medicine, Vol 5, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Michael Fogam Natasha Leigh Trent She Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus
description	Introduction: Adult intestinal malrotation with midgut volvulus is rare and most often diagnosed on abdominal imaging. Once the diagnosis is made, prompt surgical intervention is necessary. A finding suggestive of malrotation with midgut volvulus on abdominal imaging is the “whirlpool” sign where the superior mesenteric vein and superior mesenteric artery twist at the root of the abdominal mesentery. This sign was once thought to be pathognomonic, but recent studies have shown that it can be seen in asymptomatic patients. Case Report: A 20-year-old female presented to our emergency department with diffuse abdominal pain. Computed tomography demonstrated the “whirlpool” sign with a concern for malrotation with midgut volvulus. Surgical consultation was obtained and the patient was rushed to the operating room for an exploratory laparotomy. Normal mesenteric attachments were seen and no significant pathology was identified during the laparotomy. The patient was eventually diagnosed with gastritis and discharged in stable condition. Conclusion: Emergency physicians and surgeons alike should be cautious in confirming malrotation with midgut volvulus solely due to the “whirlpool” sign on abdominal imaging. Premature diagnostic closure can lead to unnecessary procedures and interventions for patients as in the case we report here.
format	article
author	Michael Fogam Natasha Leigh Trent She
author_facet	Michael Fogam Natasha Leigh Trent She
author_sort	Michael Fogam
title	Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus
title_short	Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus
title_full	Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus
title_fullStr	Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus
title_full_unstemmed	Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus
title_sort	whirlpool no more: a case of misdiagnosed malrotation with midgut volvulus
publisher	eScholarship Publishing, University of California
publishDate	2021
url	https://doaj.org/article/1e2870346e1545a5ba03cafac1b96808
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Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus

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