"Whirl Sign"

A woman came in to clinical that presented with severe abdominal pain. She was 43 years old and was 5 years post gastric bypass. Her exam was an abdomen for stone protocol. Her exam was negative for stone but showed a mid-gut volvulus, inflamed bowl, and possible ischemia. The patient’s exam also showed a “whirl sign” that is a characteristic of a gastrointestinal volvulus. The “whirl sign” is a loop of bowl that presents in a whirl or swirl pattern on CT abdominal imaging. A “whirl sign” is usually associated with rotation of the superior mesenteric vein around the superior mesenteric artery or any mesenteric rotation or looping. The radiologist then ordered a dual phase contrast study of the abdomen and pelvis. The “whirl sign” with a gastrointestinal volvulus is a possible side effect of gastric bypass surgery. This problem can present itself 3-5 years post-surgery in some cases.