Schwartz Lisa M, Perdomo Ryan M, An Jason
University of California Riverside, Department of Emergency Medicine, Riverside, CA.
J Educ Teach Emerg Med. 2022 Jan 15;7(1):V5-V7. doi: 10.21980/J83S8G. eCollection 2022 Jan.
Recognition of the whirl sign on computed tomography (CT) imaging can improve patient outcomes in those presenting with small bowel obstruction (SBO). In the case highlighted in this report, a 40-year-old woman with a remote history of gastric bypass presented to the emergency department (ED) with four hours of abdominal pain and vomiting. Findings on the initial CT of the abdomen and pelvis were suggestive of SBO with a whirl sign pattern. The whirl sign occurs after the bowel rotates around the mesentery, leading to a visual "whirl" of mesenteric vessels. Unfortunately, despite prompt diagnosis, the patient developed an ischemic bowel and ultimately sustained a prolonged hospital course requiring multiple bowel resections. ED providers should familiarize themselves with the whirl sign because its presence in patients with SBO increases the likelihood of ischemia. These patients should have urgent surgical consultation to decrease overall morbidity and mortality.
Whirl sign, small bowel obstruction, gastric bypass, internal hernia.
在计算机断层扫描（CT）成像中识别漩涡征可改善小肠梗阻（SBO）患者的治疗结果。在本报告重点介绍的病例中，一名有胃旁路手术史的40岁女性因腹痛和呕吐4小时就诊于急诊科（ED）。腹部和骨盆的初始CT检查结果提示SBO伴有漩涡征模式。漩涡征是在肠管围绕肠系膜旋转后出现，导致肠系膜血管出现视觉上的“漩涡”。不幸的是，尽管诊断及时，患者仍发生了肠缺血，最终住院时间延长，需要进行多次肠切除术。急诊科医护人员应熟悉漩涡征，因为其在SBO患者中的出现增加了缺血的可能性。这些患者应紧急进行外科会诊，以降低总体发病率和死亡率。
漩涡征、小肠梗阻、胃旁路手术、内疝
