A 72-year-old man presents with acute onset abdominal distension, cramping pain, and absolute constipation. Abdominal X-ray shows a markedly dilated loop of bowel arising from the pelvis with the 'coffee bean' sign pointing toward the right upper quadrant. CT confirms a sigmoid volvulus with no evidence of perforation or peritonitis. What is the initial management?

• A Emergency Hartmann's procedure
• B Colonoscopic decompression with rectal tube placement ✓
• C Laparoscopic sigmoidopexy
• D Rigid sigmoidoscopy with rectal tube insertion

Explanation

In sigmoid volvulus without peritonitis or perforation, initial management is endoscopic decompression. Colonoscopy allows direct visualization and decompression with rectal tube placement. Rigid sigmoidoscopy is less preferred as it has limited reach. Surgery (Hartmann's or primary anastomosis) is reserved for failed decompression or peritonitis. Sigmoidopexy alone has high recurrence rates.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.