An 80 y.o. male with a hx of colonic volvulus presents with severe abdominal pain while driving home from work.

what do you notice on his CT?

Our patient had a midgut volvulus with a whirl  sign. This is a loop of bowel visible on CT when the bowel rotates around its mesentery. Although volvulus can occur at any site in the GI tract; it most commonly occurs in the colon.

Sigmoid volvulus typically develops  in older patients( mean age 70) often with a history of constipation; although it has been reported in younger patients as well. Sigmoid volvulus the the most common cause of strangulation of the colon but constitutes less than 10% of bowel obstructions in industrialized countries.

The coffee bean sign of sigmoid volvulus

Cecal volvulus causes 3% of large bowel obstructions. Cecal volvulus tends to occur in younger patients  with a mean age of 53 in Western countries. In a cecal volvulus you will see haustra and little gas in the rest of the colon.

A cecal volulus often appears in the LUQ and the cecum is> 9 cm.

Midgut volvulus can be caused by congenital malrotations and should be considered in any young person presenting with severe abdominal pain without previous abdominal surgery. Congenital Ladd’s bands( bands of fibrous tissue) may be present connecting the cecum to the retroperitoneum.  Small bowel volvulus can also occur in patients with redundant mesentery as in our patient. The presentation is often pain out of proportion to the exam as the small bowel is ischemic.

Ladd’s bands

Our patient initially had an ileocolic volvulus which was reduced but it reoccurred requiring resection in 2019.  He presented again with midgut volvulus in 2022.  This was reduced 3/26 but required two more small bowel resections for ischemic bowel.  He recovered and was discharged.

Sarfaraz M, Hasan S, Lateef S. Sigmoid volvulus in young patients: a new twist on an old diagnosis. Intractable Rare Dis Res. 2017 Aug; 6(3) 219-223.

Safioleas M, Chatziconstantinou C, Felekouras E. et al. Clinical consideration and therapeutic strategy for sigmoid volvulus in elderly: A study of 33 cases. World J Gastroenterol 2007;13:921-24.

Butterworth W, Butterworth J. An adult presentation of midgut volvulus secondary to intestinal malrotation: a case report and literature review. Int J Surg Case Rep 2018;50:46-49.

Ton M, Ruzal-Shapiro C, Stolar C, Kazlow P. Recurrent sigmoid volvulus in a  sixteen-year-old boy:case report and review of the literature. J Pediatr Surg 2004;39:1434.