Around the twist, the sonographic whirlpool sign in a patient with a history of gastroschisis

Abstract

Introduction: This is the report of a two-year-old girl who presented with non-bilious vomiting, abdominal pain and a history of gastroschisis, for investigation of potential intussusception. Method: An abdominal ultrasound was conducted identifying the whirlpool sign suggesting mid-gut volvulus. The patient then underwent an upper GI contrast study and follow through. Written consent was obtained inclusion in this report. Results: Ultrasound identified dilated proximal small bowel and the whirlpool sign, with the superior mesenteric vein and tributaries making one-and-a-half twists around the axis of the superior mesenteric artery. Fluoroscopy demonstrated jejunal beaking with passage of some contrast. Ladd's procedure was performed, repositioning the intestines in a non-rotated position, a grossly dilated segment of jejunum was resected. Conclusion: Patients with a history of gastroschisis will also have intestinal non-rotation as the normal embryological process of gut rotation is interrupted. Because of the prolonged exposure of the eviscerated gut in utero to amniotic fluid, the affected bowel is usually inflamed, and thought to be susceptible to adhesions once reduced neonatally. These adhesions are considered to be protective by reducing bowel mobility and likelihood of future volvulus. Take home message: The sonographic whirlpool sign is an important indicator of possible mid-gut volvulus. Sonographers should be aware of this sign and its clinical significance, even in patients considered less likely to have the condition.L6165327242017-06-06 <br />