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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 I2 statistic of 0% (95% CI: 0.00–76.34) and a τ2 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. [ABSTRACT FROM AUTHOR]

Purpose: A positive whirlpool sign (WS) is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography (US), using standard, high-resolution ultrasonography (HRUS) and/or color Doppler sonography (CDS), in the presence of testicular torsion. The objective of this review was to assess the validity and accuracy of this sign by performing a comprehensive systematic literature review and meta-analysis.Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a comprehensive literature search was performed (August, 2017), using the following databases: BMJ Best Practice, Cochrane Library, Embase, PubMed, Scopus, and Web of Science. Selected studies were further assessed for relevance and quality using the Oxford 2010 Critical Appraisal Skills Program (CASP).Results: Of the studies assessed, a total of 723 participants were included, with a mean of 72.3 (SD 71.9) participants. Of the participants, 226 (31.3%) were diagnosed with testicular torsion (TT). Meta-analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity of the WS of 0.73 (95% CI, 0.65-0.79) and 0.99 (95% CI, 0.92-0.99), respectively. Removal of all neonates increased the pooled sensitivity to 0.92 (95% CI, 0.70-0.98) while the pooled specificity remained almost unchanged at 0.99 (95% CI, 0.95-1.00). The estimated summary effect of all studies with sufficient data was 4.34 (95% CI, 1.01-7.67; n = 394; p = 0.001). A large degree of heterogeneity was suggested by an I2 statistic of 88.27% (95% CI, 68.60-98.68%). Removal of neonatal subjects increased the estimated summary effect to 5.32 (95% CI, 1.59-9.05; n = 375; p = 0.001).Conclusion: The WS, when correctly diagnosed, may be viewed as a very definitive sign for TT in the pediatric and adult populations. However, its role in neonates is limited. [ABSTRACT FROM AUTHOR]