BACKGROUND The sonographic whirlpool sign of volvulus due to midgut malrotation is well recognized. However, variations of the whirlpool sign may be seen in other conditions, but this observation has received little attention in the literature. OBJECTIVE This study presents a series of neonates with a variety of causes of congenital intestinal obstruction, all associated with a whirlpool sign (unrelated to midgut volvulus), which was correctly recognized preoperatively on sonography. We also emphasize the pivotal role of sonography in managing congenital obstruction of the intestinal tract in neonates. MATERIALS AND METHODS This is a retrospective analysis of clinical, imaging and surgical findings in 11 neonates with congenital intestinal obstruction associated with a whirlpool sign (unrelated to midgut volvulus) that was recognized preoperatively on sonography and in whom the cause for the whirlpool was documented at surgery. RESULTS Eleven neonates (eight male, three female) had clinical and radiographic evidence of intestinal obstruction in whom sonography depicted a whirlpool sign, which was recognized on the initial sonogram in nine and on a repeat sonogram in two. The whirlpool was located in the upper abdomen in only two, mid-abdomen in five and right lower quadrant in four. The whirlpool was only 1-2 cm in diameter. An upper gastrointestinal series in three neonates failed to depict the cause of obstruction. Contrast enema in three cases had findings suggesting the site of obstruction was in the ileum but none depicted the exact cause of the obstruction. At surgery, the whirlpool sign correlated with a segmental volvulus of the small intestine in eight neonates and with the coiled distal small intestine associated with apple-peel atresia in the other three. CONCLUSION This study illustrates neonates in whom a whirlpool sign (unrelated to midgut volvulus) was correctly recognized on sonography before surgery. Sonography proved more useful than an upper gastrointestinal series or contrast enema in depicting the exact cause of the obstruction. Pediatric radiologists must make the effort to search throughout the entire abdomen and pelvis for a small whirlpool sign on sonography, even in the absence of midgut malrotation, in neonates with congenital intestinal obstruction. Its recognition preoperatively will facilitate a rapid diagnosis and will obviate the necessity for contrast examinations of the gastrointestinal tract, which require ionizing radiation.

中文翻译：

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超声在描绘漩涡征中的作用与新生儿中肠旋转不良无关。

背景技术由于肠中部旋转不良而引起的肠扭转的超声回旋体征已得到公认。但是，在其他情况下也可能会看到漩涡迹象的变化，但是这种观察在文献中很少受到关注。目的本研究介绍了一系列因多种原因导致的先天性肠梗阻的新生儿，这些原因均与漩涡状体征（与肠中肠扭转无关）有关，在超声检查中可以正确识别这些漩涡状体征。我们还强调了超声检查在控制新生儿先天性肠梗阻中的关键作用。材料与方法这是对临床，11例新生儿先天性肠梗阻伴有旋涡征象（与中肠肠扭转无关）的新生儿的影像学和外科检查结果，在超声检查中已被术前发现，并在手术中记录了引起旋涡的原因。结果11例新生儿（8例男性，3例女性）具有肠梗阻的临床和影像学证据，超声检查显示漩涡状体征，最初的9例和2例的超声检查均被发现。漩涡仅位于上腹部中的两个，五个中腹部，四个中的右下象限。漩涡池的直径仅为1-2厘米。在三个新生儿中的上消化道系列未能描述阻塞的原因。3例造影剂灌肠发现阻塞部位位于回肠，但没有发现阻塞的确切原因。在手术中，漩涡征与八名新生儿的小肠节段性旋转息肉相关，另外三名与苹果皮闭锁相关的远端小肠盘旋状相关。结论本研究说明了新生儿，在手术前超声检查可正确识别漩涡状体征（与中肠扭转无关）。超声检查在描述阻塞的确切原因方面比上消化道检查或对比灌肠更有用。儿科放射科医生必须努力在整个腹部和骨盆中进行超声检查，以寻找小的旋涡征象，即使没有中肠旋转不良，在患有先天性肠梗阻的新生儿中。术前对其进行识别将有助于快速诊断，并且消除了需要电离辐射的胃肠道对比检查的必要性。