Small Bowel Volvulus

  • Etiology: small bowel twists around an intra-abdominal mass (Meckel’s diverticulum, mesenteric cyst, ileal duplication) or adhesion
  • AXR: small bowel obstruction
  • US + CT: whirlpool sign
  • DDX: malrotation with midgut volvulus
  • Complications: closed loop bowel obstruction, bowel ischemia and necrosis
  • Treatment: surgical

Cases of Small Bowel Volvulus

CT of small bowel volvulus around mesenteric cyst
Two contiguous axial images from a CT with contrast of the abdomen show a whirlpool sign of swirling of the mesenteric vessels (above left) around a round low density structure just to the left of the spine (above right). Another axial image from the same exam (below left) shows a normal relationship of the superior mesenteric vein to the right of the superior mesenteric artery although both appear to be shifted to the left. AP image from a subsequent upper GI (below right) shows normal position of the ligament of Treitz in the left upper quadrant.