Journal Article

Swirl Sign — Intestinal Volvulus after Roux-en-Y Gastric Bypass

Fernandez-Moure, Joseph, Sherman, Vadim

2017

Overview

A 56-year-old man who had undergone gastric bypass 7 years earlier presented with midabdominal pain, nausea, and bilious emesis. Swirling of the bowel and mesenteric vessels, shown in a video, was noted on CT. A 56-year-old man presented after a day and a half of midabdominal pain, nausea, and bilious emesis. The patient had undergone Roux-en-Y gastric bypass 7 years earlier. During the physical examination, tachycardia and tachypnea were noted. The abdominal examination showed a distended, tympanic abdomen with severe generalized abdominal tenderness, involuntary guarding, and rebound tenderness consistent with peritonitis. Radiography (Panel A) and computed tomography (CT) (Panel B) showed dilated loops of small bowel distal to the jejunojejunostomy staple line with proximal decompression. Swirling of the bowel and mesenteric vessels was noted on CT as they herniated through the jejunojejunostomy mesenteric defect. . . .

• Publisher: Massachusetts Medical Society
• Subject: Abdomen / Case reports / Gastric Bypass / Gastrointestinal surgery / Hernia, Abdominal - diagnosis / Hernia, Abdominal - etiology / Humans / Intestinal bypass / Intestinal Volvulus - diagnostic imaging / Intestinal Volvulus - etiology / Intestine / Intestines - diagnostic imaging / Male / Middle Aged / Nausea / Pain / Postoperative Complications - diagnosis / Radiography / Tomography, X-Ray Computed / Vomiting