Presentation
Abdominal pain and vomiting. Previous surgery for teratoma.
Patient Data
CT scan documents significant fluid dilatation of the small bowel (approximately 5 cm); there is evidence of whirlpool sign and double beak sign suggestive for closed loop obstruction.
There is a small amount, most pronounced in the rectovesical space, and also very subtle collection in the right paracolic gutter and the deepest point of the Morrison's pouch.
Displaced right ureteric J stent.
Laparotomy confirms the diagnosis of small bowel volvulus.
Case Discussion
The study of intestinal occlusion requires iv contrast (the use of contrast per os is still debated 1), especially to exclude possible vascular causes (i.e. bowel ischemia).
In this case, some pathognomonic signs, such as small bowel dilatation greater than 3 cm, whirl sign and double beak sign, together with a correct communication with the surgeon, were sufficient to carry out the operation successfully.
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