CLOCKWISE WHIRLPOOL SIGN AT COLOR DOPPLER US - AN OBJECTIVE AND DEFINITE SIGN OF MIDGUT VOLVULUS

PURPOSE: To evaluate the clockwise whirlpool sign at color Doppler ult rasound (US) in the diagnosis of midgut volvulus. MATERIALS AND METHOD S: Pediatric patients (160 boys, 76 girls; age range, 0 day to 14 year s) with possible midgut volvulus underwent abdominal gray-scale US and color Doppler US. Midgut volvulus was diagnosed by recognition of the whirlpool sign (wrapping of the superior mesenteric vein and the mese ntery around the superior mesenteric artery). If the whirlpool rotated clockwise with caudal movement of the transducer, the direction of th e whirlpool was defined as clockwise. RESULTS: Color Doppler US showed a whirlpool sign that was clockwise in 12 of 13 patients with surgica lly confirmed midgut volvulus and counterclockwise in three patients w ithout midgut volvulus. Sensitivity, specificity, and positive predict ive value of clockwise whirlpool sign for midgut volvulus were 92%, 10 0%, and 100%. CONCLUSION: The clockwise whirlpool sign is diagnostic o f midgut volvulus. Color Doppler US should be performed as an initial imaging study in children suspected of having midgut volvulus.