A 72-year-old man with long-standing constipation presents with massive colonic distension seen on abdominal X-ray showing a 'coffee-bean sign.' CT confirms sigmoid volvulus. He is hemodynamically stable. What is the initial management?
- A Emergency sigmoid colectomy with primary anastomosis
- B Hartmann's procedure as emergency surgery
- C Sigmoidoscopic or flexible colonoscopic decompression followed by elective sigmoid resection ✓
- D Conservative management with IV fluids and nasogastric tube
Explanation
Sigmoid volvulus is managed initially by endoscopic decompression (rigid sigmoidoscopy or flexible colonoscopy) in hemodynamically stable patients without peritoneal signs, which is successful in approximately 70-90% of cases. The characteristic 'coffee-bean sign' or 'bent inner tube sign' on abdominal X-ray is pathognomonic. After successful decompression, elective sigmoid resection should be planned as the recurrence rate without surgery approaches 50-90%. Emergency surgery (Hartmann's procedure or resection with anastomosis) is indicated for perforation, peritonitis, or failed endoscopic decompression.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.