Images in Clinical Medicine: Volvulus in National Cheng-Kung University (台南國立成功大學醫學院), Tainan, Taiwan

There is an “Image in Clinical Medicine” on each issue of New England Journal of Medicine (N.E.J.M.) It didn’t escape my notice that there were two images of volvulus within the past few years and both came from the same hospital: National Cheng-Kung University (台南國立成功大學醫學院), Tainan, Taiwan.

I took the liberty to put these images in my blog to convey my heartfelt congratulations.  These four doctors deserve much recognition as it is not easy to get the image published in the prestigious and venerable N.E.J.M., which is celebrating its 200^th anniversary this year. (MGH had its bicentennial celebration last year).

Volvulus is the torsion (twisting) of a segment of intestine, which often leads to bowel obstruction or even gangrene because of circulatory compromise in severe case.  The most common sites are sigmoid or cecum, as reported by Ping-Hsien Chen, M.D. and Chiao-Hsiung Chuang, M.D.  It can also happen in the small intestine as reported by Ming-Yuan Hong, M.D. and Chih-Hsien Chi, M.D.

The Images published also come with a short case report and description of the images.  These doctors did it splendidly; the followings are their images and descriptions.

The above CT image shows a distended sigmoid colon that was looped in an inverted U (Panel A, arrows).  The coronal view reveals dilated loops of colon with a central whirl sign (Panel B, arrow), [which is characteristic of the volvulus.  This was caused by the dilated sigmoid colon around its mesocolon (the peritoneal fold that attaches to the sigmoid)].

The above abdominal computed tomography with intravenous contrast material revealed twisting of mesenteric pedicles (arrows), with the superior mesenteric artery encircled by the superior mesenteric vein in a 360-degree clockwise rotation. This radiologic finding is known as the “whirl sign,” which occurs when bowel loops rotate around a fixed point of obstruction, suggesting intestinal volvulus.