The Medieval Armenian Symbol of Eternity in the Art of the Twelfth-Century Italian Sculptor Nicholaus: A Veiled Performance

The medieval Armenian symbol of eternity – a whirl sign – is engraved in the forehead of five bull sculptures dated to the first half of the twelfth century, attributable to the workshop of the Italian sculptor Nicholaus. The whirl is an ancient sacred symbol associated with eternal life, not specific to any religion or culture, that has persisted for millennia. The following carvings display a closely resembling geometric whirl engravure: in the apse frieze of Koenigslutter Kaiserdom (Lower Saxony), in the pulpit of Sacra di Carpi (Modena), in the “Creation of animals” panel of S. Zeno Basilica (Verona), in the Verona Cathedral porch, and in the Ferrara Cathedral narthex. This symbol, generally ignored by Western Christian art after the Carolingian period, was revisited by the Nicholaus workshop. We argue that the small, hitherto overlooked whirl engraving made by these artists in the bull head of Koenigslutter, Carpi, Ferrara and Verona was a veiled ornamental performance displaying the symbol of eternity to signify the concept of life in the hereafter. Here the immediate inspiration source was likely Armenian, because in the early twelfth century the geometric whirl symbol of eternity was foreign to Italian religious decorations while it was deeply rooted in Armenian Christian art. Nicholaus and his atelier were familiar with the leaved cross and the whirl – traditional Armenian motifs symbolizing life in the hereafter – and were inspired by them in some of their works. In the decorative reliefs of S. Zeno Basilica façade, Verona Cathedral porch and Koenigslutter Kaiserdom frieze, various examples of the geometric whirl metamorphosis into naturalistic foliate whirl are extant, witnessing the Nicholaus atelier’s versatile sculptural performance in conceptualizing everlasting life.

Small Bowel Volvulus In Adult: A Review Of Literature

A Small bowel volvulus is a rare entity where the small bowel loop twists around its own mesentery. These twisting may produce a mechanical obstruction, vascular compromise, or both. In North America and Western Europe, the annual incidence of small bowel volvulus is 1.7 to 5.7 cases per 100,000, but much higher rates of 24 to 60 cases per 100,000 have been observed in Africa, Asia, the Middle East, and India. Small bowel volvulus can be classified as primary and secondary subtypes. In primary variety, there is no known cause whereas secondary variety occurs due to the presence of predisposing lesions, either congenital or acquired of which postoperative adhesion is the most common responsible factor. The most commonly accepted explanation for the initiation of primary small bowel volvulus is the abnormal bowel peristalsis generated due to the sudden overfilling of the empty bowel loop with a large portion of meal after prolong fasting. Secondary small bowel volvulus is commonly seen in the elderly population with mixed gender distribution. There are no specific clinical features or laboratory findings and a high index of suspicion is required to reach a diagnosis. Abdominal pain is the most common presenting feature of small bowel volvulus. CT scan is the investigation of choice and a whirl sign is the characteristic finding of bowel volvulus. Urgent Surgical exploration is the treatment of choice to prevent complications due to vascular compromise. Although small bowel volvulus is rare, it has a mortality rate between 9% and 35%, which can reach up to 100% if associated with bowel necrosis.

Abdominal Computed Tomography with a Twist: The ‘Whirl Sign’ for Mesenteric Volvulus

Case Presentation: A 55-year-old woman with a history of end-stage renal disease, peripheral vascular disease, and multiple prior abdominal surgeries presented to the emergency department with three days of diffuse, severe, abdominal pain with accompanying nausea, emesis, and food intolerance. A computed tomography (CT) of her abdomen demonstrated a “whirl” of small bowel and mesenteric vessels, raising suspicion for mesenteric volvulus and resultant small bowel obstruction. Discussion: Mesenteric volvulus is a low incidence, high mortality condition; therefore, early recognition and operative intervention are critical. Patients with a “whirl sign” on CT are more likely to require surgical intervention for their small bowel obstruction.

Whirl Sign and Midgut Volvulus: An Unusual Cause of an Acute Abdomen in an Adult Patient

We report the case of a 50-year-old lady who presented to the emergency department complaining of a two-day history of colicky right upper quadrant (RUQ) pain, which radiated through to her back, associated with nausea, anorexia, and two episodes of vomiting that day. She was found to be tender in the RUQ. Her blood tests were notable for an elevated white cell count. Initial impression was of acute cholecystitis. Ultrasound of her abdomen did not identify any features of acute cholecystitis; however, a large volume of free fluid was identified within the abdomen. CT of the abdomen/pelvis was obtained which identified dilated loops of small bowel, interloop ascites, and a whirl sign highly suggestive of midgut volvulus. During laparoscopy, the midgut volvulus was found to have resolved. No cause for the volvulus could be identified, and the patient was discharged home well on postoperative day two.