A 75-year-old patient with sigmoid volvulus on plain AXR (coffee bean/bent inner tube sign with apex pointing to right upper quadrant) is hemodynamically stable and has no peritonitis. What is the first-line treatment?
- A Emergency sigmoid colectomy with end colostomy (Hartmann's procedure)
- B Endoscopic decompression via rigid sigmoidoscopy or flexible colonoscopy with rectal tube placement ✓
- C Gastrografin enema to reduce volvulus
- D Laparoscopic reduction of volvulus without resection
Explanation
In hemodynamically stable sigmoid volvulus without peritonitis or bowel ischemia, endoscopic decompression (rigid or flexible sigmoidoscopy with rectal tube placement) is the first-line treatment, achieving detorsion in > 80% of cases. After successful decompression, elective sigmoid colectomy is performed within the same admission (usually within 48–72 hours) because the recurrence rate without surgery is > 40–90%. Emergency surgery is required for failed endoscopic decompression, signs of ischemia, perforation, or peritonitis. Gastrografin enema has no role in sigmoid volvulus decompression. Laparoscopic reduction without resection has very high recurrence.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.