A 75-year-old woman presents with gross abdominal distension and absolute constipation for two days. Abdominal radiograph shows a massively dilated loop arising from the pelvis with its apex under the left hemidiaphragm. She has no signs of peritonitis. After resuscitation, the next step in management is:
- A Flexible sigmoidoscopy with insertion of a flatus tube, followed by consideration of elective sigmoid colectomy ✓
- B Immediate emergency laparotomy with sigmoid colectomy
- C Barium enema for hydrostatic reduction
- D Nasogastric decompression and observation only
Correct answer: A. Flexible sigmoidoscopy with insertion of a flatus tube, followed by consideration of elective sigmoid colectomy
Explanation
Uncomplicated sigmoid volvulus without peritonitis or perforation is treated first by endoscopic detorsion and decompression, with a flatus tube left in situ to maintain the decompressed state. Because recurrence rates approach 50 percent, elective sigmoid colectomy is offered during the same admission in fit patients. Laparotomy is reserved for suspected gangrene, perforation, or failed endoscopic reduction, and barium enema reduction is obsolete because of perforation risk.
Reference: Bailey and Love Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.