Computed tomography whirl sign: An image-based indication for surgery.

Adhesive closed-loop small bowel obstruction can lead to volvulus and ischemia with risk of necrosis. The vital prognosis and bowel viability are highly dependent on rapid management. The physical examination is often insufficient to establish the diagnosis and computed tomography is ordered. The whirl sign provides the best imaging evidence of volvulus and can be sufficient to establish the indication for surgery.