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Role of the ultrasonographic ‘whirlpool sign’ in intestinal volvulus: a systematic review and meta‐analysis
Author(s) -
Enyuma Callistus O. A.,
Adam Ahmed,
Aigbodion Sunday J.,
McDowall Jared,
Gerber Louis,
Buchanan Sean,
Laher Abdullah E.
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14495
Subject(s) - medicine , bowel infarction , meta analysis , confidence interval , medline , systematic review , critical appraisal , sample size determination , surgery , pathology , alternative medicine , political science , law , statistics , mathematics
Background Intestinal volvulus is a potentially life‐threatening condition that occurs when loops of bowel twist around its supporting mesentery and associated vasculature. Clinicians often rely on various radiological investigations for prompt diagnosis to avoid complications such as bowel infarction. This review assesses the clinical reliability of the ultrasonographic whirlpool sign (WS) in the diagnosis of intestinal volvulus. Methods In adherence with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta‐analyses) statement, a systematic search of BMJ Best Practice, Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus and Web of Science databases was performed (August 2017) , using relevant search terms. Selected studies were ranked for quality and relevance using the CASP (Critical Appraisal Skills Program) tool. Results Sixteen articles (1640 participants) were assessed. The mean and median sample size was 102.5 (SD ± 192.23) and 28 (range 7–770), respectively. The WS was positive in 212 of 255 (83.1%) patients with intestinal volvulus. Meta‐analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity of 87.42% (95% confidence interval (CI): 81.05–92.25) and 98.63% (95% CI: 97.88–99.18), respectively, with an estimated summary effect of 5.28 (95% CI: 4.47–6.08, P < 0.001). There was negligible inter‐study heterogeneity, which was suggested by an I 2 statistic of 0% (95% CI: 0.00–76.34) and a τ 2 parameter of 0 (95% CI: 0.00–5.35). Conclusion Though the pooled sensitivity was less than ideal (87.42%), this review and meta‐analysis nevertheless supports the reliability of the ultrasonographic WS as an acceptable indicator of intestinal volvulus.