Abdominal Computed Tomography Scan Research Articles

A Cross-Sectional Validation of Horos and CoreSlicer Software Programs for Body Composition Analysis in Abdominal Computed Tomography Scans in Colorectal Cancer Patients.

Body composition assessment using computed tomography (CT) scans may be hampered by software costs. To facilitate its implementation in resource-limited settings, two open-source segmentation programs (Horos and CoreSlicer) were transversally validated in colorectal cancer patients. Contrast-enhanced abdominal CT scans were analyzed following the Alberta protocol. The Cross-Sectional Area (CSA) and intensities of skeletal muscle tissue (MT), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intramuscular adipose tissue (IMAT) were measured. The Skeletal Muscle Index (SMI) was calculated. Cutoff points were applied to the SMI, MT intensity, and VAT CSA to define muscle atrophy, myosteatosis, and abdominal obesity. The inter-software agreement was evaluated using different statistical tools. A total of 68 participants were measured. The MT CSA and SMI displayed no differences. The MT CSA agreement was excellent, and both programs provided equal muscle atrophy prevalences. CoreSlicer underestimated the MT intensity, with a non-significant myosteatosis prevalence increase (+5.88% and +8.82%) using two different operative definitions. CoreSlicer overestimated the CSA and intensity in both VAT and SAT, with a non-significant increase (+2.94%) in the abdominal obesity prevalence. Both software programs were feasible tools in the study group. The MT CSA showed great inter-software agreement and no muscle atrophy misdiagnosis. Segmentation differences in the MT intensity and VAT CSA caused limited diagnostic misclassification in the study sample.

Validation of an automated segmentation method for body composition analysis in colorectal cancer patients using diagnostic abdominal computed tomography images

Background & AimsSeveral automated programs have been developed to facilitate body composition analysis of images from abdominal computed tomography (CT) scans. External validation in patients with colorectal cancer is necessary for use in research and clinical practice. Our aim was to validate an automatic method (AutoMATiCA) of segmenting CT images at the third lumbar level (L3) from patients with colorectal cancer, by comparing with manual segmentation. MethodsDiagnostic abdominal CT scans of consecutive patients with stage I-III colorectal cancer were analysed to measure cross-sectional areas and tissue densities of skeletal muscle and intra-muscular, visceral, and subcutaneous adipose tissue. Trained analysts performed manual segmentation of L3 CT images using SliceOmatic. Automatic segmentation was performed using AutoMATiCA, an open-source software. The Dice similarity coefficient (DSC) was calculated to assess segmentation accuracy. Agreement of automatic with manual segmentation was evaluated using intra-class correlation coefficients (ICCs) and Bland-Altman plots with limits of agreement. ResultsA total of 292 scans were included, of which 62% were from male patients. The agreement of AutoMATiCA with the manual segmentation was excellent, with median DSC values ranging from 0.900-0.991 and ICCs above 0.95 for all segmented areas. No systematic deviations were observed in Bland-Altman plots for all segmented areas, with overall narrow limits of agreement. ConclusionsAutoMATiCA provides an accurate segmentation of abdominal CT images from patients with colorectal cancer. Our findings support its use as a highly efficient automated tool for body composition analysis in research and potentially also in clinical practice.

Sarcopenia as a prognostic factor in patients with hepatocellular carcinoma treated with transcatheter arterial chemoembolization plus sorafenib.

Loss of skeletal muscle volume is an important aspect of sarcopenia in hepatocellular carcinoma (HCC) patients treated by surgical resection, transcatheter arterial chemoembolization (TACE), or sorafenib. This study determined the influence of sarcopenia and other laboratory results on survival in patients with HCC treated with TACE plus sorafenib. The patients were divided into two groups based on the presence of sarcopenia. The skeletal muscle index was calculated by normalizing the cross-sectional muscle area at the L3 level on an abdominal computed tomography scan before embolization according to the patient's height. The clinical characteristics of the two groups were then compared. The progression-free survival (PFS) and overall survival (OS) rates after treatment were determined. Sarcopenia was present in 75 of the 102 (74%) patients with HCC included in this study. The albumin, prealbumin, and cholinesterase levels were lower in those with sarcopenia. The OS (P = 0.001) and PFS (P = 0.008) were significantly prolonged in the nonsarcopenia group compared to the sarcopenia group. Sarcopenia, ECOG (≥2), and prealbumin (<180 mg/L) were significantly associated with PFS. Sarcopenia, ECOG (≥2), Child-Pugh B, BCLC stage C, prealbumin (<180 mg/L), and cholinesterase (<5,320 U/L) were significantly associated with OS. The prognostic factors for OS included sarcopenia, ECOG (≥2), and cholinesterase (<5,320 U/L), whereas only ECOG (≥2) was identified as a prognostic factor for PFS. Sarcopenia may be an indicator of poor clinical outcome in patients with HCC receiving TACE plus sorafenib.

Small bowel occlusion due to congenital peritoneal encapsulation treated with laparoscopic resection of the hernia sac: A diagnostic and therapeutic challenge

Congenital peritoneal encapsulation (CPE) is an extraordinarily rare condition characterized by an additional peritoneal membrane encasing part or whole of the small intestine. The etiology of CPE, believed to originate from atypical adhesions during fetal mid-gut development, remains uncertain. Clinical presentations involving intestinal obstruction are extremely rare. We report a case of a 39-year-old male of Egyptian origin who presented to our emergency department with abdominal pain and vomiting. Initial abdominal computed tomography scan showed no mechanical obstruction. However, worsening symptoms necessitated laparoscopic exploration, which revealed a mechanical obstruction in the jejunum due to a peritoneal-vessel band and CPE involving the initial segment of the small bowel. The peritoneal fold, encircling the first jejunal loops, was resected up to the Treitz ligament, releasing the jejunum. The patient had an uncomplicated postoperative recovery and was discharged on the fourth postoperative day.

Deep Learning–Based Prediction of Hepatic Decompensation in Patients With Primary Sclerosing Cholangitis With Computed Tomography

ObjectiveTo investigate a deep learning model for predicting hepatic decompensation using computed tomography (CT) imaging in patients with primary sclerosing cholangitis (PSC). Patients and MethodsRetrospective cohort study involving 277 adult patients with large-duct PSC who underwent an abdominal CT scan. The portal venous phase CT images were used as input to a 3D-DenseNet121 model, which was trained using 5-fold crossvalidation to classify hepatic decompensation. To further investigate the role of each anatomic region in the model’s decision-making process, we trained the model on different sections of 3-dimensional CT images. This included training on the right, left, anterior, posterior, inferior, and superior halves of the image data set. For each half, as well as for the entire scan, we performed area under the receiving operating curve (AUROC) analysis. ResultsHepatic decompensation occurred in 128 individuals after a median (interquartile range) of 1.5 years (142-1318 days) after the CT scan. The deep learning model exhibited promising results, with a mean ± SD AUROC of 0.89±0.04 for the baseline model. The mean ± SD AUROC for left, right, anterior, posterior, superior, and inferior halves were 0.83±0.03, 0.83±0.03, 0.82±0.09, 0.79±0.02, 0.78±0.02, and 0.76±0.04, respectively. ConclusionThe study illustrates the potential of examining CT imaging using 3D-DenseNet121 deep learning model to predict hepatic decompensation in patients with PSC.

Age of obesity onset affects subcutaneous adipose tissue cellularity differently in the abdominal and femoral region.

We aimed to examine the effect of age of obesity onset, sex, and their interaction on abdominal and femoral subcutaneous adipose tissue (SAT) morphology (degree of adipocyte hyperplasia or hypertrophy). In this cross-sectional study, we isolated adipocytes via collagenase digestion from abdominal and femoral SAT biopsies taken from maleand femaleadults with childhood-onset obesity (CO; n = 8 males, n = 16 females) or adult-onset obesity (AO; n = 8 males, n = 13 females). Regional body composition was measured with dual-energy x-ray absorptiometry and a single-slice abdominal computed tomography scan. Mean adipocyte size was measured in abdominal and femoral SAT and was used to quantify morphology in android and gynoid subcutaneous fat, respectively. Abdominal SAT morphology was more hyperplastic in females with CO than females with AO (p = 0.004) but did not differ between males with CO and males with AO (p = 0.996). Conversely, femoral SAT morphology was more hypertrophic in males and females with CO than those with AO. Age of obesity onset appears to affect SAT morphology differently in the abdominal and femoral regions of male and female adults. Our findings challenge the notion that SAT is uniformly hyperplastic in CO and hypertrophic in AO.

An Analysis of Computed Tomography Diagnostic Reference Levels in India Compared to Other Countries.

Computed Tomography (CT) is vital for diagnosing and monitoring medical conditions. However, increased usage raises concerns about patient radiation exposure. Diagnostic Reference Levels (DRLs) aim to minimize radiation doses in CT imaging. This study examines CT DRLs in India compared to other countries to identify optimization opportunities. A literature review was conducted to gather data from published studies, guidelines, and regulatory authorities. Findings show significant international variations in CT DRLs, with differences up to 50%. In India, DRLs also vary significantly across states. For head CT exams, Indian DRLs are generally 20-30% lower than international standards (27-47 mGy vs. 60 mGy). Conversely, for abdominal CT scans, Indian DRLs are 10-15% higher (12-16 mGy vs. 13 mGy). Factors influencing DRL variations include equipment differences, imaging protocols, patient demographics, and regulatory conditions. Dose-optimization techniques like automatic exposure control and iterative reconstruction can reduce radiation exposure by 25-60% while maintaining image quality. Comparative data highlight best practices, such as the United Kingdom's 30% reduction in CT doses from 1984 to 1995 via DRL implementation. This study suggests that adopting similar practices in India could reduce radiation doses by 20-40% for common CT procedures, promoting responsible CT usage and minimizing patient exposure.

Optimizing computed tomography image reconstruction for focal hepatic lesions: Deep learning image reconstruction vs iterative reconstruction

BackgroundDeep learning image reconstruction (DLIR) is a novel computed tomography (CT) reconstruction technique that minimizes image noise, enhances image quality, and enables radiation dose reduction. This study aims to compare the diagnostic performance of DLIR and iterative reconstruction (IR) in the evaluation of focal hepatic lesions. MethodsWe conducted a retrospective study of 216 focal hepatic lesions in 109 adult participants who underwent abdominal CT scanning at our institution. We used DLIR (low, medium, and high strength) and IR (0 %, 10 %, 20 %, and 30 %) techniques for image reconstruction. Four experienced abdominal radiologists independently evaluated focal hepatic lesions based on five qualitative aspects (lesion detectability, lesion border, diagnostic confidence level, image artifact, and overall image quality). Quantitatively, we measured and compared the level of image noise for each technique at the liver and aorta. ResultsThere were significant differences (p < 0.001) among the seven reconstruction techniques in terms of lesion borders, image artifacts, and overall image quality. Low-strength DLIR (DLIR-L) exhibited the best overall image quality. Although high-strength DLIR (DLIR-H) had the least image noise and fewest artifacts, it also had the lowest scores for lesion borders and overall image quality. Image noise showed a weak to moderate positive correlation with participants’ body mass index and waist circumference. ConclusionsThe optimal-strength DLIR significantly improved overall image quality for evaluating focal hepatic lesions compared to the IR technique. DLIR-L achieved the best overall image quality while maintaining acceptable levels of image noise and quality of lesion borders.

Splenic rupture following prone lateral discectomy and arthrodesis: illustrative case.

The prone lateral approach to lumbar spine surgery is known to have a multitude of potential complications, including damage to neurovascular structures, surrounding viscera, and intra-abdominal structures near the surgical site. However, iatrogenic injury to the spleen following prone lateral lumbar discectomy and arthrodesis as a potential complication has not yet been described in the literature. The authors present the case of a 71-year-old female with a history of L3-S1 laminectomy and L3-5 arthrodesis who underwent a prone lateral discectomy of L2-3 with arthrodesis of the endplates for chronic lower-back pain. On postoperative day 1, the patient developed hypotension unresponsive to pressor medications, significant abdominal pain, and anemia requiring 2 transfusions. Bedside ultrasound revealed free fluid in the abdomen. She then underwent an exploratory laparotomy for splenic injury. Although rare, splenic rupture should be considered as part of the differential diagnosis for patients with hemodynamic instability after lateral surgical approaches to the lumbar spine. Any patient with evidence of hypotension, anemia, and/or abdominal pain following lumbar surgery should be evaluated for splenic injury with an abdominal computed tomography scan and considered for surgical intervention. https://thejns.org/doi/10.3171/CASE23639.

Paradoxical embolic stroke during catheter-directed thrombolytics in a patient with massive pulmonary embolism

Abstract Paradoxical embolism represents a critical and potentially fatal complication that can be associated with pulmonary embolism (PE). This case details a unique case of massive PE, further complicated by embolic stroke occurring during catheter-directed thrombolytic therapy. There was no evidence of thrombosis during the initial evaluation with lower extremity Doppler ultrasound, abdominal computed tomography scan, and transthoracic echocardiography. Differentials for the source of the emboli include unrecognized left atrial appendage thrombus, pulmonary arteriovenous malformations, and a patent left foramen ovale. Our findings highlight the complexities and treatment challenges of massive PE.

Challenges in the diagnosis and treatment of pure non-gestational uterine choriocarcinoma in a child: a case report

BackgroundDiagnosing non-gestational uterine choriocarcinoma in children is challenging because of its rarity and nonspecific imaging findings. Herein, we report a case of non-gestational uterine choriocarcinoma in a child, which was unexpectedly found during exploratory laparotomy and confirmed by histopathological findings. However, the tumor did not respond to chemotherapy.Case presentationA 4-year-old Indonesian female patient was brought into the emergency unit with chief complaint of vaginal bleeding. She had suffered from vaginal spotting 4 months before being admitted to the hospital. Physical examination revealed a distended abdomen in the left lumbar region and a palpable fixed mass with a smooth surface. Abdominal computed tomography scans revealed a large mass (10 × 6 × 12 cm) with fluid density and calcification. Thus, we suspected left ovarian teratoma. The patient’s luteinizing hormone, follicle-stimulating hormone, and lactate dehydrogenase levels were 25.2 mIU/ml, 0.1 mIU/ml, and 406 U/l, respectively. According to the clinical and radiological findings, we decided to perform an exploratory laparotomy and found a tumor originating from the uterus, not the ovarium. We did not observe liver nodules and any enlargement of abdominal lymph nodes. Subsequently, we performed hysterectomy. The histopathological findings supported the diagnosis of choriocarcinoma. The patient was discharged uneventfully on postoperative day 5. Thereafter, the patient underwent nine cycles of chemotherapy, including carboplatin (600 mg/m2 IV), etoposide (120 mg/m2 IV), and bleomycin (15 mg/m2 IV). However, on the basis of the clinical findings of a palpable mass and partial intestinal obstruction, the tumor relapsed soon after the ninth cycle of chemotherapy. Currently, the patient is undergoing chemotherapy again.ConclusionsAlthough pure non-gestational uterine choriocarcinoma is rare, it should be considered as one of the differential diagnoses for intraabdominal tumors in a child, so as to better guide and counsel families regarding the surgical plan and prognosis, respectively. In the present case, the patient’s response to chemotherapy was poor, implying that the treatment of non-gestational choriocarcinoma is still challenging, particularly in the pediatric population.

Extraskeletal osteosarcoma infiltrating pancreas, spleen, gastric, and left kidney: a case report

BackgroundExtraskeletal osteosarcoma is an extremely rare malignancy that accounts for 1% of soft tissue sarcoma and 4.3% of all osteosarcoma. Extraskeletal osteosarcoma can develop in a patient between the ages of 48 and 60 years. The incidence of extraskeletal osteosarcoma is slightly higher in male patients than in females.Case presentationA 50-year-old Caucasian male patient presented with a 6-month history of intermittent lower-left back pain that limits his activity. Prior ultrasonography and abdominal computed tomography scan showed a diagnosis of kidney stone and tumor in the lower-left abdomen. The computed tomography urography with contrast revealed a mass suspected as a left retroperitoneal malignant tumor. Hence, the tumor was resected through laparotomy and the patient continued with histopathological and immunohistochemistry examination with the result of extraskeletal osteosarcoma.ConclusionExtraskeletal osteosarcoma presents diagnostic challenges requiring multimodal examination, including histological and immunohistochemistry analyses. This case underscores the aggressive nature and poor prognosis despite undergoing the current suggested treatment.

Transarterial embolization in Wunderlich syndrome due to recanalization of giant renal angiomyolipoma pseudoaneurysm: a case report and literature review

BackgroundAcute spontaneous bleeding from renal angiomyolipoma (AML) is one of the causes of Wunderlich syndrome, a rare and potentially fatal clinical condition. Clinical deterioration will occur if there is a delay in urgent management. There are several management options for renal angiomyolipoma rupture. However, until now little is known about the case of recanalization from post-coil embolization of renal angiomyolipoma. There is no guideline about embolization technique for the management of recurrent bleeding after embolization or coil recanalization of renal angiomyolipoma.Case presentationA 55-year-old male has Wunderlich syndrome caused by recurrent bleeding of giant AML of the left renal due to coil recanalization compounded by a pseudoaneurysm and other bleeding site in bilateral giant renal angiomyolipoma which is showed by contrast-enhanced abdominal computed tomography scan. The patient underwent urgent transarterial embolization and some blood transfusion. Clinical improvement occurred and the patient discharged several days later.ConclusionsEmbolization for spontaneous bleeding or rebleeding of renal pseudoaneurysms may become the first choice of treatment in bilateral multiple renal angiomyolipoma rather than other managements which are available to preserve renal function.

In senile patients with severe disease, the diagnostic effect of enhanced abdominal computerized tomography scan is affected by high quality nursing interventions

In senile patients with severe disease, the diagnostic effect of enhanced abdominal computerized tomography scan is affected by high quality nursing interventions

A Novel Timing Equation for Predicting Optimal Contrast Medium Enhancement in Abdomen CT Scan Procedure

Abdominal CT (Computed Tomography) scans are crucial for diagnosing a wide range of abdominal conditions by providing detailed images of the abdominal organs. The aim of this study is to develop and validate a novel timing equation for predicting optimal contrast medium enhancement in abdominal CT procedures. Utilizing a quantitative research design, data was retrospectively collected from 155 patients who underwent CT scans with contrast media, focusing on variables such as age, gender, weight, creatinine levels, and injection parameters. Statistical analysis, including multi-linear regression and ANOVA, was conducted to derive predictive equations for arterial, venous, and delayed times. The results indicated that Location of the cannula significantly influence arterial time, age is significantly influence venous enhancement time, while weight was the only significant predictor of delayed time, demonstrating the need for patient-specific timing in CT scans. In conclusion, the proposed timing equation could enhance diagnostic accuracy and patient care by optimizing contrast enhancement in abdominal CT procedures.

Incidence of intra-abdominal injuries in hemodynamically stable blunt trauma patients with a normal computed tomography scan admitted to the emergency department

ObjectivesBlunt abdominal trauma is a common cause of emergency department admission. Computed tomography (CT) scanning is the gold standard method for identifying intra-abdominal injuries in patients experiencing blunt trauma, especially those with high-energy trauma. Although the diagnostic accuracy of this imaging technique is very high, patient admission and prolonged observation protocols are still common practices worldwide. We aimed to evaluate the incidence of intra-abdominal injury in hemodynamically stable patients with high-energy blunt trauma and a normal abdominal CT scan at a Level-1 Trauma Center in Colombia, South America, to assess the relevance of a prolonged observation period.MethodsWe performed a retrospective study of patients admitted to the emergency department for blunt trauma between 2021 and 2022. All consecutive patients with high-energy mechanisms of trauma and a normal CT scan at admission were included. Our primary outcomes were the incidence of intra-abdominal injury identified during a 24-hour observation period or hospital stay, ICU admission, and death.ResultsWe included 480 patients who met the inclusion criteria. The median age was 33 (IQR 25.5, 47), and 74.2% were male. The most common mechanisms of injury were motor vehicle accidents (64.2%), falls from height (26%), and falls from bikes (3.1%). A total of 99.2% of patients had a Revised Trauma Score of 8. Only 1 patient (0.2%) (95% CI: 0.01–1.16) presented with an abdominal injury during the observation period. No ICU admissions or deaths were reported.ConclusionThe incidence of intra-abdominal injury in patients with hemodynamically stable blunt trauma and a negative abdominal CT scan is extremely low, and prolonged observation may not be justified in these patients.

Low-iodine-dose computed tomography coupled with an artificial intelligence-based contrast-boosting technique in children: a retrospective study on comparison with conventional-iodine-dose computed tomography

BackgroundLow-iodine-dose computed tomography (CT) protocols have emerged to mitigate the risks associated with contrast injection, often resulting in decreased image quality.ObjectiveTo evaluate the image quality of low-iodine-dose CT combined with an artificial intelligence (AI)-based contrast-boosting technique in abdominal CT, compared to a standard-iodine-dose protocol in children.Materials and methodsThis single-center retrospective study included 35 pediatric patients (mean age 9.2 years, range 1–17 years) who underwent sequential abdominal CT scans—one with a standard-iodine-dose protocol (standard-dose group, Iobitridol 350 mgI/mL) and another with a low-iodine-dose protocol (low-dose group, Iohexol 240 mgI/mL)—within a 4-month interval from January 2022 to July 2022. The low-iodine CT protocol was reconstructed using an AI-based contrast-boosting technique (contrast-boosted group). Quantitative and qualitative parameters were measured in the three groups. For qualitative parameters, interobserver agreement was assessed using the intraclass correlation coefficient, and mean values were employed for subsequent analyses. For quantitative analysis of the three groups, repeated measures one-way analysis of variance with post hoc pairwise analysis was used. For qualitative analysis, the Friedman test followed by post hoc pairwise analysis was used. Paired t-tests were employed to compare radiation dose and iodine uptake between the standard- and low-dose groups.ResultsThe standard-dose group exhibited higher attenuation, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) of organs and vessels compared to the low-dose group (all P-values < 0.05 except for liver SNR, P = 0.12). However, noise levels did not differ between the standard- and low-dose groups (P = 0.86). The contrast-boosted group had increased attenuation, CNR, and SNR of organs and vessels, and reduced noise compared with the low-dose group (all P < 0.05). The contrast-boosted group showed no differences in attenuation, CNR, and SNR of organs and vessels (all P > 0.05), and lower noise (P = 0.002), than the standard-dose group. In qualitative analysis, the contrast-boosted group did not differ regarding vessel enhancement and lesion conspicuity (P > 0.05) but had lower noise (P < 0.05) and higher organ enhancement and artifacts (all P < 0.05) than the standard-dose group. While iodine uptake was significantly reduced in low-iodine-dose CT (P < 0.001), there was no difference in radiation dose between standard- and low-iodine-dose CT (all P > 0.05).ConclusionLow-iodine-dose abdominal CT, combined with an AI-based contrast-boosting technique exhibited comparable organ and vessel enhancement, as well as lesion conspicuity compared to standard-iodine-dose CT in children. Moreover, image noise decreased in the contrast-boosted group, albeit with an increase in artifacts.Graphical

A Novel Liver Tumor segmentation of Adverse Propagation Advanced Swin Transformer Network with Mask region-based convolutional neural networks

The diagnosis and treatment of liver diseases from computed tomography (CT) images is an indispensable task for segmentation of Liver & its tumours. Due to the uneven presence, fuzzy borders, diverse densities, shapes and sizes of lesions segmentation of liver & its tumour is a difficult task. At this point we mainly focused on deep learning algorithms for segmenting liver and its tumour from abdominal CT scan images thereafter minimising the time & energy used for a liver diseases diagnosis This study aims to classify and segment liver tumors using a novel deep learning-based model. A Mask region-based convolutional neural network (Mask R-CNN) model is proposed for multiorgan segmentation to aid esophageal radiation treatment. Due to the fact that organ boundaries may be fuzzy and organ shapes are various, original Mask R-CNN works well on natural image segmentation while leaves something to be desired on the multiorgan segmentation task. Addressing it, the advantages of this method are threefold: (1) a ROI (region of interest) generation method is presented in the RPN (region proposal network) which is able to utilize multiscale semantic features. (2) A prebackground classification subnetwork is integrated to the original mask generation branch to improve the precision of multiorgan segmentation. The segmented image is added to the Adverse Propagation Advanced Swin Transformer Network (APESTNet) to prevent overfitting. The proposed model is based on CT volume slices of patients with liver tumors and evaluated on the public 3D dataset IRCADB01.The proposed model dataset is split into training as 60% and testing as 40 % for classification. The proposed model's accuracy and recall are 99.23 % and 98.24 %, respectively.

A cross-sectional study on the correlation of image quality, effective dose, and body composition with thyroid, chest, and abdominal computed tomography scans

A cross-sectional study on the correlation of image quality, effective dose, and body composition with thyroid, chest, and abdominal computed tomography scans

Quadruple (1440 degrees) intestinal volvulus

Key Clinical MessageA whirl sign on contrast‐enhanced abdominal CT scan is indicative of intestine twisted around the mesenteric vessels, and is observed in cases of strangulated obstruction, signaling compromised intestinal circulation. In cases of intestinal volvulus, surgery is necessary to untwist the affected bowel, and resection is necessary if necrosis is present.AbstractA 31‐year‐old Japanese man presented with acute lower abdominal pain and vomiting. Contrast‐enhanced abdominal computed tomography (CT) revealed a 1440‐degree clockwise torsion of superior mesenteric artery and a whirl sign. Intestinal volvulus in adulthood with a background of malrotation is extremely rare. Contrast‐enhanced CT is effective for diagnosis.