- 期刊
"Whirlpool Sign": Typical Finding by Abdominal Computed Tomography in a Patient with Intestinal Malrotation and Midgut Volvulus
"旋渦池徵象"：腸道迴旋不全併中腸扭轉於腹部電腦斷層中之典型表現
摘要
中腸迴旋不全導致腸扭轉的情形在成人族群相當少見，然而一旦發生時，腸道與網膜的緊密絞扭，大多急速引起阻塞、缺血性壞死甚至於敗血性休克的後果。本文所述病例是一位21歲的男性患者，在飯後出現急遽的上腹疼痛與嘔吐。臨床檢查呈現出彌漫性腹脹、壓痛及反彈痛，其腹痛即使以麻醉性止痛藥均難以控制，緊急腹部電腦斷層發現典型的“漩渦池徵象”：小腸腸道與上腸繫膜靜脈迴繞著上腸繫膜動脈呈螺旋狀的緊密絞扭。施行立即剖腹手術時發現：在混合型迴旋的先天腸道異常下，十二指腸發生順時鐘方向的絞扭，導致小腸腸道缺血性壞死，手術將壞死區段加以切除。腹部電腦斷層中典型的“漩渦池徵象”，可提供明確診斷及早進行手術。
並列摘要
Midgut malrotation leading to volvulus is rarely seen in adults and is often complicated by obstruction, ischemic necrosis and septic shock. Tight twisting of the gut and mesentery can result in a rapid downhill course. We present a 21-year-old man who had suffered from episodic postprandial epigastric pain and vomiting of undigested food since childhood. He was admitted to hospital because of severe epigastric pain and vomiting for one hour. Physical examination revealed a distended abdomen with diffuse tenderness and rebounding pain. Emergent computed tomography showed the superior mesenteric artery wrapped by coils of superior mesenteric vein and bowel. This condition, known as the “whirlpool sign”, is valuable in the diagnosis of midgut malrotation with volvulus. Clockwise twisting of the duodenum complicated by gangrenous change of the small intestine at the base of mixed rotation was found in our patient during surgical intervention. The “whirlpool sign” is pathognomonic for preoperative diagnosis of midgut volvulus and mandates prompt surgery.