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CT Whirl Useful in Managing Small-Bowel Obstruction

March 9, 2009
Written by: , Filed in: Gastrointestinal Imaging
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You’ve seen it—the CT whirl sign when imaging the small bowel. But have you considered its significance in predicting patient outcome in the management of small-bowel obstruction?

A study reported in the September 2008 issue of the American Journal of Roentgenology looked at the CT whirl and reported some interesting findings.

They found that a patient with a CT whirl was approximately 25 times more likely to require surgery to treat a small-bowel obstruction.

The study was a retrospective analysis comprised of 194 patients who had a diagnosis of small-bowel obstruction made with radiologic criteria and follow-up information.

The images were evaluated for the presence of a CT whirl sign, which was defined as twisting of the bowel greater than 90° surrounding a central soft-tissue density of mesentery and vessels.

Of the 40 patients who had the CT whirl, 32 had small-bowel obstruction that required surgical treatment for a positive-predictive value of 80%. The other eight received successful medical treatment.

The odds ratio between the presence and absence of the whirl sign and predicting small-bowel obstruction requiring surgery was approximately 25.Therefore, a patient with a CT whirl sign and small-bowel obstruction is 25 times more likely to require surgery than a patient without the sign.

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists

We should all keep this in mind when observing the CT whirl, as these results are useful in demonstrating the impact of finding a CT whirl sign in the management of patients with clinical and radiologic evidence of small-bowel obstruction.

Note, however, that one of the limitations to consider is that it was not determined how often whirl sign occurred in patients who did not have a diagnosis of small-bowel obstruction.

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Reference: Duda JB, Bhatt S, Dogra VS. Utility of CT Whirl Sign in Guiding Management of Small-Bowel Obstruction. AJR 2008; 191 (September): 743–747.

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