A 70-year-old man with a history of previous sigmoid colectomy presents with abdominal distension, absolute constipation, and colicky pain. Plain AXR shows a coffee bean sign arising from the pelvis pointing to the right upper quadrant. CT confirms sigmoid volvulus. He has no signs of peritonitis. Immediate management is:

• A Emergency Hartmann's procedure
• B Nasogastric tube decompression and colonoscopy the next day
• C Endoscopic detorsion via rigid sigmoidoscopy or flexible colonoscopy ✓
• D Resection and primary anastomosis immediately

Explanation

In sigmoid volvulus without gangrene or peritonitis, the first-line management is endoscopic detorsion (rigid sigmoidoscopy or colonoscopy) with placement of a rectal flatus tube, which decompresses the bowel and avoids emergency surgery. Elective sigmoid colectomy is planned after resuscitation. Emergency surgery is reserved for gangrenous bowel or failed endoscopic detorsion.

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.