PMC6423352_01
Plain abdominal x-ray in supine position (Red arrows: multiple dilated small bowel loops (jejunum and ileum). Blue arrow: Air fluid level in large bowel loop in the right upper quadrant suspected to be sigmoid colon).
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Plain abdominal radiographs showed dilated small and large bowel loops (Fig. 1).
Abdominal CT with contrast, two coronal views: (a) white arrow shows suspected sigmoid volvulus in the right upper quadrant. Green arrow shows dilated small bowel loop. (b) yellow arrow demonstrates preihepatic free fluid, red arrow points at non-enhancing small bowel loop and edematous roots of mesentery, blue arrow shows swirl sign and the suspected site of hernia aperture.
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Swirl sign at the mesentery of cecum suspected strangulated bowels due to transmesentric defect (Fig. 2).
Intraoperative surgical site showing left side of patient (A) Gangrenous distal ileum, right side of patient (B) gangrenous sigmoid colon, (C) viable jejuna loop. The arrow points at the site of trans-mesentric herniation.
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Intraoperative findings: 2 x 4 cm defect in the mesentery of cecum, Gangrenous sigmoid volvulus and part of the terminal ileum entrapped through the mesenteric gate, and much free fluid (Fig. 3).