A 70-year-old man presents with absolute constipation, distension, and obstipation for 3 days. Abdominal X-ray shows a massively dilated loop of sigmoid colon with a 'coffee bean sign.' He is haemodynamically stable. The first-line treatment is:

• A Emergency laparotomy with Hartmann's procedure
• B Endoscopic decompression (flexible sigmoidoscopy) and rectal tube placement
• C Gastrografin enema and observation
• D Colonoscopic decompression followed by elective sigmoid colectomy ✓

Explanation

Sigmoid volvulus presenting in a stable patient without peritonitis is managed first with endoscopic decompression (rigid or flexible sigmoidoscopy with flatus tube placement), which achieves reduction in >85% of cases. However, the recurrence rate without definitive surgery is >50%, so elective sigmoid colectomy after bowel preparation is recommended to prevent recurrence. Hartmann's procedure is reserved for gangrenous bowel or peritonitis.

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.