A 70-year-old woman with known osteoarthritis on NSAIDs presents with acute severe abdominal pain and vomiting. CT abdomen reveals a 'whirl sign' and 'beak sign' of small bowel mesentery. What diagnosis and management does this indicate?

• A Adhesive small bowel obstruction; conservative management with nasogastric decompression
• B Small bowel volvulus with mesenteric torsion; emergency laparotomy for detorsion ✓
• C Closed loop obstruction with ischemia; urgent CT-guided decompression
• D Strangulated femoral hernia; emergency hernia repair

Explanation

The CT 'whirl sign' (twisting of mesenteric fat and vessels) and 'beak sign' (narrowing at point of torsion) are pathognomonic of small bowel volvulus or closed-loop obstruction with mesenteric torsion. This constitutes a surgical emergency due to the risk of bowel ischemia, necrosis, and perforation. Emergency laparotomy for detorsion (and bowel resection if non-viable bowel is found) is required. NSAIDs explain GI symptoms but are not the cause. Closed-loop obstruction on CT has additional findings including the 'C-shaped' or 'U-shaped' dilated loop with fixed ends.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.