{"pk":1101,"title":"Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus","subtitle":null,"abstract":"Introduction:\n Adult intestinal malrotation with midgut volvulus is rare and most often diagnosed on abdominal imaging. Once the diagnosis is made, prompt surgical intervention is necessary. A finding suggestive of malrotation with midgut volvulus on abdominal imaging is the “whirlpool” sign where the superior mesenteric vein and superior mesenteric artery twist at the root of the abdominal mesentery. This sign was once thought to be pathognomonic, but recent studies have shown that it can be seen in asymptomatic patients.\nCase Report:\n A 20-year-old female presented to our emergency department with diffuse abdominal pain. Computed tomography demonstrated the “whirlpool” sign with a concern for malrotation with midgut volvulus. Surgical consultation was obtained and the patient was rushed to the operating room for an exploratory laparotomy. Normal mesenteric attachments were seen and no significant pathology was identified during the laparotomy. The patient was eventually diagnosed with gastritis and discharged in stable condition.\nConclusion:\n Emergency physicians and surgeons alike should be cautious in confirming malrotation with midgut volvulus solely due to the “whirlpool” sign on abdominal imaging. Premature diagnostic closure can lead to unnecessary procedures and interventions for patients as in the case we report here.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"malrotation"},{"word":"midgut volvulus"},{"word":"whirlpool sign"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2z8583tc","frozenauthors":[{"first_name":"Michael","middle_name":"","last_name":"Fogam","name_suffix":"","institution":"Mount Sinai St. Luke’s and Mount Sinai West, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Natasha","middle_name":"","last_name":"Leigh","name_suffix":"","institution":"Mount Sinai St. Luke’s and Mount Sinai West, Department of Surgery, New York, New York","department":"None"},{"first_name":"Trent","middle_name":"","last_name":"She","name_suffix":"","institution":"Mount Sinai St. Luke’s and Mount Sinai West, Department of Emergency Medicine, New York, New York","department":"None"}],"date_submitted":"2021-10-28T21:32:07-07:00","date_accepted":"2021-10-28T21:32:07-07:00","date_published":"2021-10-28T21:33:28-07:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1101/galley/842/download/"}]}