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Cecal Volvulus Diagnosed with a Whirl Sign: A Case Report

Gregory K Sun, DO* and Brian Walsh, MD*

*Morristown Medical Center, Department of Emergency Medicine, Morristown, NJ

Correspondence should be addressed to Gregory K Sun, MD at gregoryksun@gmail.com

DOI: https://doi.org/10.21980/J8XM05 Issue 5:4
Abdominal/GastroenterologyVisual EM
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ABSTRACT:

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.

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CTIssue 5:4

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