A 70-year-old woman presents with colicky central abdominal pain, distension, and absolute constipation for 3 days. AXR shows massively dilated sigmoid colon, and on CT the 'coffee bean' sign is present. No peritonism is found. What is the FIRST-LINE treatment?
- A Endoscopic decompression (flexible sigmoidoscopy with flatus tube placement) ✓
- B Emergency Hartmann's procedure
- C CT-guided percutaneous colonic decompression
- D IV neostigmine for pseudo-obstruction
Correct answer: A. Endoscopic decompression (flexible sigmoidoscopy with flatus tube placement)
Explanation
The 'coffee bean' sign on CT and the clinical picture indicate sigmoid volvulus. In a haemodynamically stable patient without signs of ischaemia or perforation, the first-line treatment is endoscopic decompression via flexible sigmoidoscopy with placement of a flatus tube. This is successful in approximately 70-85% of cases. After successful decompression, elective sigmoid colectomy is planned to prevent recurrence (recurrence rate without surgery is 50-90%). Emergency surgery is reserved for failed endoscopy 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.