Midgut volvulus secondary to intestinal malrotation is a rare cause of acute abdomen in adults. Appendicular agenesis is an exceptionally uncommon congenital anomaly, and its coexistence is exceedingly rare. An 18-year-old woman presented with acute-on-chronic abdominal pain, nausea, and vomiting, with a long history of recurrent gastrointestinal symptoms. A contrast-enhanced computed tomography revealed a whirlpool sign suggestive of midgut volvulus. Exploratory laparotomy demonstrated a 540° clockwise midgut volvulus, type I (non-rotation) intestinal malrotation with Ladd's bands, a high-riding cecum, and congenital absence of the vermiform appendix. A standard Ladd's procedure was performed, excluding appendectomy. Adult intestinal malrotation often presents with vague, nonspecific symptoms, leading to diagnostic delay. A shortened mesenteric root predisposes to midgut volvulus, a potentially life-threatening complication. Appendicular agenesis should be considered when the appendix cannot be identified despite meticulous exploration. This case highlights a rare association of adult midgut volvulus with appendicular agenesis. Early imaging, high clinical suspicion, and prompt surgical intervention are essential for optimal outcomes.
Ileosigmoid knotting (ISK) is a rare form of compound volvulus in which ileal loops wrap around the sigmoid colon or vice versa, producing a rapidly progressive closed-loop obstruction with a high risk of ischemia. Prompt computed tomography (CT) recognition is essential, as clinical findings are often non-specific, and deterioration can occur quickly. We report the case of a previously healthy adult who presented with abrupt, severe abdominal pain and progressive distension. CT revealed a double closed-loop configuration involving the distal ileum and sigmoid colon, a prominent whirlpool sign, reduced mural enhancement of ileal loops, mesenteric congestion, and localized free fluid. Emergency laparotomy confirmed ISK, with non-viable ileal segments requiring resection. The postoperative course was uneventful. This case highlights the critical role of CT in diagnosing ISK and identifying early signs of ischemia. Systematic assessment of anatomy, loop orientation, and enhancement characteristics is essential to expedite surgical management.
Torsion of abdominal and pelvic organs, such as the spleen, gallbladder, omentum, epiploic appendages, fallopian tube, and epididymis/testicular appendix are relatively rare, and yet clinically significant, often imitating more common causes of acute pain. Given the nonspecific presentation and limited value of laboratory tests, imaging drives early recognition and timely, organ-preserving management. This review consolidates pathophysiology, modality-specific appearances, and practical diagnostic strategies for uncommon non-intestinal torsions. The unifying mechanism is rotation around a mesenteric or vascular stalk that first impedes venous outflow, then compromises arterial supply, culminating in edema, ischemia, and possible infarction. Predisposing conditions include congenital ligamentous or mesenteric insufficiency and acquired factors such as trauma, pregnancy, mass effect, and age-related laxity. Ultrasound may demonstrate organ enlargement, asymmetric morphology of paired organs, and, when captured, the twisted pedicle ('whirlpool' sign). Doppler findings may support the diagnosis but preserved arterial signals do not exclude torsion. CT allows clearest delineation of organ displacement, pedicle twisting, hypoenhancement, and inflammatory fat stranding. CT is especially helpful in diagnosing splenic and gallbladder torsion and in distinguishing omental torsion from epiploic appendagitis. MRI, as a radiation-sparing alternative, reliably depicts early ischemic change and variations of pelvic anatomy. Management varies from conservative therapy for epiploic appendage torsion to urgent detorsion or definitive resection for splenic, biliary and gonadal torsions. Familiarity with cross-sectional hallmarks, modality-appropriate workflows can shorten time to intervention and enhance organ salvage and outcomes.
Primary small intestinal volvulus (PSIV) is a rare cause of acute bowel obstruction in adults and is exceptionally uncommon in the very elderly. It occurs when the small intestine twists around its mesenteric axis without an identifiable secondary cause, such as adhesions or hernias. This case report describes a 91-year-old woman who presented with abdominal pain and minimal rectal bleeding, posing a diagnostic challenge in the context of multiple comorbidities and atypical symptoms. CT imaging demonstrated a persistent "whirlpool sign," raising suspicion for volvulus, and the patient underwent emergency laparotomy with detorsion and resection of nonviable segments. Despite advanced age and high perioperative risk, the patient achieved a favorable postoperative outcome following timely surgical intervention. This case highlights the diagnostic difficulty of PSIV in the very elderly population and underscores the importance of early operative management to prevent progression to bowel ischemia and reduce morbidity and mortality.
Adnexal torsion is responsible for 2.7% of gynecological emergencies. Ultrasound is the test of choice for this diagnosis, but there is some evidence of non-significant difference between ultrasound and computed tomography, in terms of sensitivity and specificity. We present a case of ovarian torsion, in which the ultrasound examination was technically suboptimal, and computed tomography imaging had an important diagnostic role, demonstrating a "Whirlpool sign". This case emphasizes the importance of the use of different and complementary imaging modalities, and the importance of reinterpretation of imaging in clinical practice.
Ovarian torsion is a surgical emergency in which twisting of the ovarian vascular pedicle leads to ischaemia. Although an uncommon diagnosis in prepubescent girls, prompt recognition of this condition is essential in order to prevent ovarian necrosis, which can have long-term consequences in terms of fertility. Transabdominal ultrasound is the recommended imaging modality for diagnosing ovarian torsion; however, given the limited availability of paediatric-trained sonographers, patients may not obtain the necessary imaging in a timely manner. Point-of-care ultrasound performed by emergency department personnel has emerged as a useful adjunct to clinical examination and one that can help expedite specialist involvement. We describe two cases of prepubescent ovarian torsion presenting to our Paediatric Emergency Department, where point-of-care ultrasound played a key role in diagnosis and expediting definitive surgical management.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, with 25-30% arising from the small intestine. While GISTs commonly present with abdominal pain or gastrointestinal bleeding, they may rarely manifest as acute surgical emergencies such as small bowel volvulus (SBV). Presentation with diffuse metastatic disease, including umbilical involvement (Sister Mary Joseph's nodule), at initial diagnosis is exceptionally uncommon. A 60-year-old woman presented with acute abdominal pain, vomiting, and obstipation for 2 days. Clinical examination revealed a soft, non-tender, distended abdomen with preserved bowel sounds. Imaging revealed small bowel obstruction with the characteristic whirlpool sign, a pelvic mass, diffuse peritoneal deposits, a Sister Mary Joseph's nodule, and a hepatic lesion. Emergency laparotomy revealed a 13.0 × 7.5 × 6.5 cm jejunal mesenteric mass causing a 180° anticlockwise volvulus with widespread peritoneal, omental, and umbilical nodules. Segmental jejunal resection with jejunojejunal anastomosis was performed for symptom palliation. Histopathology confirmed spindle-cell GIST, positive for CD117 and DOG1, with a mitotic count of 1/5 mm2 and a Ki-67 index of 3%. The tumor was staged as pT4 Nx M1 and categorized as high-risk. The patient recovered uneventfully and was started on treatment with imatinib mesylate. SBV secondary to GIST is rare and typically occurs in the presence of large extramural tumors that act as a lead point for mesenteric rotation. This case highlights the insidious biological behavior of GISTs, wherein prolonged asymptomatic growth may culminate in advanced metastatic disease at presentation, despite low proliferative indices. The presence of Sister Mary Joseph's nodule further signifies advanced intra-abdominal dissemination and poor prognostic implications. GISTs should be considered in cases of unexplained SBV. This case emphasizes the diagnostic challenges, the need for prompt surgical palliation, and the role of systemic tyrosine kinase inhibitors in advanced presentation of GIST.
Fetal intestinal volvulus is a rare intrauterine condition associated with potentially severe neonatal morbidity. Owing to its rarity, diagnostic features and management strategies remain heterogeneous and are largely based on case reports and small case series. We performed a retrospective single-center analysis of all patients diagnosed with intestinal volvulus between 2005 and 2022, comparing antenatally diagnosed fetal volvulus and postnatal presentation, diagnostic findings, management approaches, and outcomes. Given the rarity of fetal volvulus, the analysis was descriptive in nature. 45 patients with confirmed volvulus were analyzed, including seven fetal and 38 postnatal volvulus cases. Five fetal cases required postnatal surgical intervention, whereas two extremely preterm fetuses were managed conservatively with close prenatal surveillance and showed spontaneous regression of sonographic findings. Prenatal diagnosis relied mainly on ultrasound features, such as bowel distension and whirlpool sign. Outcomes in both groups were strongly influenced by gestational age and prematurity-related morbidity. Fetal volvulus presents with heterogeneous clinical courses and requires individualized, multidisciplinary decision-making. Conservative observation may be considered in selected stable cases diagnosed at extreme prematurity, whereas at more advanced gestational ages, signs of fetal deterioration may prompt consideration of delivery and postnatal surgical management. Due to the limited cohort size, no standardized treatment recommendations can be derived.
Intestinal malrotation is a congenital anomaly of the midgut resulting from abnormal embryonic rotation. Although predominantly a neonatal diagnosis, it is an extremely rare, isolated finding in adolescents, often presenting with nonspecific symptoms that lead to diagnostic delays and increased morbidity. We report a 17-year-old male presenting with acute abdominal pain, distension, and vomiting. Diagnosis was established via contrast-enhanced computed tomography (CT), which identified spiral rotation of mesenteric vessels and colonic displacement. The patient initially underwent a laparoscopic Ladd's procedure; however, postoperative complications involving duodenal stenosis and recurrent obstruction required a conversion to a Billroth II gastrojejunostomy with a Braun anastomosis. This case highlights that while the Ladd's procedure remains the surgical standard, the management of malrotation in older patients presents unique challenges compared to neonates. Unlike pediatric cases often associated with other malformations, adolescent presentation is typically isolated and insidious, making contrast-enhanced CT essential for identifying the "whirlpool sign" and avoiding misdiagnosis. Furthermore, this report underscores that chronic inflammation or recurrence in adults may demand surgical strategies beyond the standard procedure. In complex scenarios with recurrent obstruction, reconstructive techniques such as the Billroth II gastrojejunostomy with Braun anastomosis or Roux-en-Y gastric bypass are effective alternatives to prevent alkaline gastritis and ensure long-term symptom resolution.
A 1-year-old boy with a known left undescended testis presented with 7 days of fever, irritability, and progressive lower-abdominal distension. He was febrile and tachycardic with a firm lower-abdominal mass and an empty left hemiscrotum; white blood cells 17 × 109/L, C-reactive protein 200 mg/L, platelets 680 × 109/L, hemoglobin 6.8 g/dL. Ultrasound showed a heterogeneous avascular intra-abdominal mass; computed tomography showed a large cystic lesion containing fat and calcifications with a left pedicle "whirlpool sign". Urgent laparotomy with detorsion and excision revealed prepubertal-type testicular teratoma. This case highlights torsion's abdominal presentation in cryptorchidism and the value of prompt surgery and timely orchiopexy.
Ovarian cyst pedicle torsion (OT) has a high clinical misdiagnosis rate, and its early diagnosis largely relies on single ultrasound indicators. This study aimed to integrate multimodal ultrasound parameters (including structural morphology, hemodynamics, and spatial features) and key clinical indicators to construct a risk analysis and prediction model for OT, thereby providing a standardized tool for the early diagnosis of OT. The clinical data of 301 patients with ovarian cysts indicated by ultrasound at Gansu Provincial Maternity and Child Health Hospital from September 2021 to December 2023 were retrospectively analyzed. The patients were randomly divided into a training set (n=210, including 101 cases in the OT group and 109 cases in the non-OT group) and a test set (n=91, including 43 cases in the OT group and 48 cases in the non-OT group) at a ratio of 7:3. Multimodal ultrasound parameters were extracted, including structural morphology parameters (cyst diameter, cyst wall thickness, and unilocular/multilocular structure), hemodynamic parameters (pedicle blood flow signals: whirlpool-like/spiral/other types), and spatial feature parameters [cyst location, and heterogeneous nodules adjacent to the cyst (HNACs)]. A clinical indicator (pregnancy status) was also included. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors of OT, and a nomogram model was constructed. Receiver operating characteristic (ROC) curve, calibration curve, and clinical decision curve analyses were performed to evaluate the model's discriminative ability, calibration performance, and clinical applicability. The multivariate logistic regression analysis showed that the independent risk factors for OT included a cyst diameter of 5-10 cm [odds ratio (OR) =2.768, 95% confidence interval (CI): 2.205-10.872], cyst wall thickness (OR =1.409, 95% CI: 1.119-1.775), whirlpool-like/spiral blood flow in the pedicle (OR =0.26/0.31, 95% CI: 0.08-0.87/0.12-0.97; note: an OR <1 reflects the degree of torsion rather than a protective effect), a HNAC (OR =6.014, 95% CI: 2.315-13.242), a right-sided cyst (OR =4.256, 95% CI: 1.492-12.138), a multilocular cyst (OR =2.555, 95% CI: 1.088-5.999), and pregnancy status (OR =0.316, 95% CI: 0.105-0.954). The nomogram showed excellent discriminative ability [training set: area under the curve (AUC) =0.919, 95% CI:0.877-0.963; test set: AUC =0.876, 95% CI: 0.804-0.949]. Calibration curves revealed good consistency between the predicted probabilities and actual incidence, and the decision curve analysis confirmed the high net benefit across a wide risk threshold range. Our multimodal ultrasound-based prediction model, which integrates structural, hemodynamic, and spatial parameters, achieved strong internal validation for OT risk prediction. This tool assisted clinicians to rapidly standardize OT risk assessment in this single-center cohort, reducing misdiagnosis, and providing reliable support for clinical decision-making. External multicenter prospective studies are required to further validate its broader applicability.
Adnexal torsion is a rare condition, but it should be considered in any pregnant patient with acute-onset abdominal pain. In this case report, a pregnant woman at 35 weeks of gestation presented with one week of alternating abdominal pain. Sonography showed an enlarged ovary with normal Doppler flow, but a typical whirlpool sign suggestive of ovarian torsion. A minilaparotomy was performed, which confirmed left-sided adnexal torsion. The ovary was detorsed, resulting in partial restoration of the ovary's colour. A cystectomy was performed, and the patient was discharged the following day.
Gravitational water vortex turbines (GWVTs) have emerged as promising hydrokinetic technology for energy extraction in riverine systems characterized by low flow velocity and ultra-low head, where conventional hydropower solutions are not feasible. In this study, a three-dimensional computational fluid dynamics (CFD) model is developed to investigate turbine performance within a conical basin configuration. The numerical framework, validated against published reference data, is used to systematically evaluate the influence of airfoil axial spacing, chord sizing, and airfoil profile, on vortex structure and power coefficient. The results demonstrate that basin-induced flow control plays a critical role in enhancing tangential momentum transfer to the rotor. Among the investigated cases, a configuration employing a NACA0024 ducted airfoil with a chord size of 35 mm and an axial spacing of 50 mm yielded the highest power coefficient of 0.419 compared to the baseline basin power coefficient of 0.313 and reached a maximum value of 0.736 at higher inlet velocities. Performance analysis based on tip speed ratio (TSR) further identified an optimal low-TSR operating range consistent with gravitational water vortex turbine characteristics. Compared with previous GWVT studies that focus on turbine geometry, the present work highlights the effectiveness of basin wall airfoil design as an impactful strategy for performance enhancement in low-head hydrokinetic applications.
BACKGROUND: Internal hernia–related small bowel obstruction (SBO) is a time-critical condition that may rapidly progress to strangulation and bowel necrosis. Early surgical decision-making is challenging because classical clinical and radiological signs of ischemia are often absent during the reversible phase. This study aimed to identify clinical, imaging, and biochemical factors associated with bowel strangulation and delayed surgical intervention in patients with internal hernia–related SBO. METHODS: This retrospective cohort study included patients who underwent surgery for internal hernia–related SBO between January 2019 and December 2025. Admission laboratory parameters and preoperative non-enhanced abdominal computed tomography (CT) findings were analyzed. Multivariable logistic regression was used to identify predictors of bowel strangulation and factors associated with delayed surgical intervention. Clinical outcomes were compared between delayed and non-delayed surgery groups. RESULTS: A total of 119 patients were included, of whom 82 (68.9%) had strangulated internal hernia. Lactate (OR = 3.975) and D-dimer (OR = 3.412) were independent predictors of bowel strangulation. In patients with strangulated internal hernia, the absence of peritonitis (OR = 0.021), absence of the whirlpool sign on CT (OR = 0.147), and higher base excess (OR = 1.274) were independently associated with delayed surgical intervention. Patients in the delayed surgery group had significantly higher rates of bowel resection (85.7% vs. 53.2%), bowel necrosis, and longer hospital stays compared with those undergoing timely surgery. CONCLUSION: Surgical delay in internal hernia–related SBO is frequently driven by deceptively mild clinical and radiological findings during early ischemia. While lactate and D-dimer indicate established strangulation, base excess—together with non-enhanced CT features—may provide earlier warning of mesenteric compromise. An integrated interpretation of laboratory and imaging findings may facilitate earlier surgical intervention, reduce bowel resection, and improve clinical outcomes.
The impact of food wastes (FW) on suspended growth systems like the activated sludge process and in large plants with anerobic digestion has been widely studied. However, information on impact on hybrid systems and biofilm processes used for intensification, as well as with aerobic biosolids digestion, is scant. This modeling study investigated the performance, operational costs, and greenhouse gas (GHG) emissions of multiple wastewater treatment technologies-membrane bioreactor (MBR), moving bed biofilm reactor (MBBR), integrated fixed film activated sludge (IFAS), membrane aerated biofilm reactor (MABR), and oxidation ditch at the 1 and 10 MGD scales. FW addition achieved effluent total nitrogen reductions of 30%-35% for the MBR, MBBR, and IFAS, up to 85% for the MABR, and up to 70% for the oxidation ditch systems. Aeration demand increased by up to 16%-34% while biosolids production and methane production rose by <13%, and 29%-38%, respectively. Food COD conversion efficiency to methane was 35%-48%. At 100% FW addition, despite a 30% increase in organic loading, the GHG emissions increased by 3.7%-11.2% for the MBR, MBBR, and IFAS, and decreased by 5.2%-11.2% for the MABR. Anaerobic digestion mitigated GHG emissions from food wastes compared to aerobic digestion, with COD-based carbon footprints 50%-90% lower than wastewater.
Gallbladder is twisted in gallbladder torsion and abdominal symptoms rapidly progress. Timely and accurate diagnosis and treatment is essential. This disease is frequently misdiagnosed as acute cholecystitis and rarely occurs in children. Whirlpool sign and absent blood flow in the cystic artery were identified in a 12-year-old boy presenting with suspected acute cholecystitis. Computed tomography revealed simple cholecystitis, whereas ultrasound suggested gallbladder torsion. Emergency laparoscopic surgery confirmed distended gallbladder torsion, leading to cholecystectomy. Ultrasonic whirlpool is valuable for preoperative diagnosis, whereas laparoscopy is reliable for definitive diagnosis and therapeutic intervention, providing insight for diagnosis and treatment of gallbladder torsion.
Mesonephric-like adenocarcinoma (MLA) in the corpus uteri is a highly aggressive malignant tumor, which is easily confused with other types of endometrial cancer. When the tumor morphology and cellular characteristics are not consistent with the clinical biological behavior, attention should be paid to it. This study is to investigate the clinicopathologic features of MLA in the corpus uteri. Three cases of MLA in the corpus uteri diagnosed in the First Affiliated Hospital of Xi'an Jiaotong University from 2020 to 2023 were studied by clinical data, microscopic features and immunohistochemistry. The related literature was reviewed. The clinical manifestations of the three cases of MLA in the corpus uteri were nonspecific. One case was from our hospital and the other two cases were from other hospitals. The age range was 54-58 years. In the specimen description, there was a diffusely growing mass in the endometrium of the uterus, with an uneven surface and tough texture. The muscle wall was extensively invaded. At low magnification, the tumor cells were arranged in tubular, glandular, papillary, micropapillary and solid growth patterns. At high magnification, the cells lining the lumen were arranged in a single layer, cuboidal or columnar pattern, with mild to moderate atypia, with vesicular nuclei and nuclear furrows. Some of the lumens showed eosinophilic homogeneous pink staining without structural-like material. In the solid area, the cells were plat fusiform, arranged in bundles or whirlpools, with large nuclear atypia and frequent mitotic figures. A large number of intravascular cancer thrombus were observed in all the three cases. The tumor cells were positive for GATA3 and/or thyroid transcription factor-1 (TTF1), diffusely positive for pair box gene 2 (PAX2) and PAX8, and positive for CD10 in some luminal margins. Estrogen receptor (ER) was focal positive, and progesterone receptor (PR) was negative. KRAS mutation was detected in case 1. According to the 2023 updated International Federation of Gynecology and Obstetrics (FIGO) staging guidelines for endometrial cancer, all the three cases were in advanced stage. It is suggested that pathologists should make accurate diagnosis based on morphological manifestations, using a set of matched immunohistochemical markers and necessary molecular tests to avoid misdiagnosis and better guide clinical diagnosis and treatment. 子宫体中肾样腺癌(mesonephric-like adenocarcinoma, MLA)是一种具有高度侵袭性的恶性肿瘤, 易与其他类型子宫内膜癌混淆, 当肿瘤形态及细胞特征与临床生物学行为不相符时, 更需引起注意。为探讨子宫体MLA的临床病理特征, 本研究收集西安交通大学第一附属医院2020—2023年确诊的3例子宫体MLA患者的临床资料及病理切片, 复习镜下特点及免疫组织化学表型, 并进行文献回顾。3例患者临床表现无特异性, 其中1例为本院诊治患者, 2例为外院会诊患者, 年龄为54~58岁。肿瘤表现为宫腔内膜面弥漫型肿物, 表面凹凸不平, 向下广泛侵及肌壁; 低倍镜下见肿瘤细胞排列成小管状、腺管状、乳头状、微乳头状、实性等多种生长模式, 高倍镜下见管腔内衬细胞单层排列, 呈立方状或柱状, 细胞轻到中度异型, 可见泡状核及核沟; 部分管腔内可见嗜酸性均质粉染无结构物; 实体区细胞呈胖梭形, 排列呈束状或漩涡状, 核异型性较大, 核分裂象易见; 3例均可见大量的脉管内癌栓。免疫组织化学染色显示GATA3和/或甲状腺转录因子1(thyroid transcription factor-1, TTF1)阳性, 配对盒基因2(pair box gene 2, PAX2)、PAX8弥漫阳性, 部分腔缘可见CD10阳性表达; 雌激素受体(estrogen receptor, ER)小灶阳性, 孕激素受体(progesterone receptor, PR)阴性。例1分子检测显示有KRAS基因突变。根据2023年国际妇产科联盟(International Federation of Gynecology and Obstetrics, FIGO)子宫内膜癌分期, 3例均处于晚期。本组病例提示, 病理医生在诊断中需基于形态学表现, 采用一组免疫组织化学标记物及分子检测做出准确诊断, 避免误诊, 以更好地指导临床治疗。
An acute scrotum is an urological emergency. One of its most important causes is testicular torsion, which can result in testicular necrosis unless quickly diagnosed and treated. Along with point-of-care ultrasound (POCUS), the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score can be used to differentiate between testicular torsion and other causes of an acute scrotum. However, their diagnostic performance when undertaken by emergency physicians (EPs) and paediatricians in the emergency department (ED), as opposed to urologists/radiologists, is uncertain. This retrospective observational study investigated patients aged ≤15 years with an acute scrotum who visited a paediatric tertiary care hospital's ED between March 2018 and August 2022. The diagnostic accuracy of the TWIST score and POCUS when performed by EPs and paediatricians to diagnose testicular torsion was calculated. Each TWIST score served as a cut-off. For practical purposes, a cutoff ≥3 points was used for sensitivity and the negative predictive value (NPV), and a cutoff ≥5 points was used for specificity and the positive predictive value (PPV). The final diagnosis served as the reference standard. Of 512 patients, 55 (11%) had testicular torsion. The TWIST score had 91% sensitivity (95% CI 80%-97%), 95% specificity (95% CI 93% to 97%), 63% PPV (95% CI 50% to 75%) and 99% NPV (95% CI 97% to 100%). When positivity was defined as either impaired testicular blood flow or the whirlpool sign, the sensitivity, specificity, PPV and NPV were 96% (95% CI 87% to 100%), 95% (95% CI 93% to 97%), 70% (95% CI 58% to 80%) and 100% (95% CI 98% to 100%) respectively. Although the TWIST score and POCUS had high diagnostic accuracy for paediatric testicular torsion when performed by EPs or paediatricians in the ED, the non-negligible, false-negative rate indicated that the TWIST score should be used for risk stratification rather than as an exclusionary method.
Midgut volvulus, a complication of intestinal malrotation, is a surgical emergency. Due to its embryologic aetiology, it is predominantly seen in neonates; with about 90% of cases involving children under the age of 1. The majority of these are diagnosed within the first month of life. However, midgut volvulus has been reported in adults of varying ages across the literature. We present a case of a 16-year-old girl with generalised but severe abdominal pain in the central and lower abdomen. Ultrasound revealed a clockwise malrotation of the bowel with involvement of the superior mesenteric vessels, in keeping with the 'whirlpool sign'. The proximal duodenum appeared distended. Within the whirlpool, there was evidence of peristalsis in the bowel loops and blood flow in the mesenteric vessels, suggesting a lack of ischaemia in the involved bowel loops. Three months later, the patient was presented to the emergency department with symptoms of vomiting and severe abdominal pain. Computed tomography scan revealed a mesenteric swirl in the mid-abdomen involving the mesenteric vessels, consistent with the previous ultrasound findings of midgut volvulus, and the proximal duodenum remained distended. Midgut volvulus is often overlooked in older children and teenagers presenting with abdominal pain, largely due to its rarity in these age groups. Our case emphasises the importance of clinicians maintaining an open mind and considering imaging, particularly ultrasound, as part of the initial evaluation.