A 78-year-old woman presents with sudden abdominal distension and absolute constipation. Abdominal radiograph shows a grossly dilated loop arising from the pelvis with a 'coffee bean' appearance. She is haemodynamically stable with no signs of peritonitis. What is the correct initial management?

• A Flexible sigmoidoscopic detorsion and decompression followed by elective sigmoid colectomy ✓
• B Emergency laparotomy with sigmoid colectomy
• C Barium enema for reduction alone, with no further intervention
• D Nasogastric decompression and conservative observation

Explanation

Uncomplicated sigmoid volvulus without gangrene or perforation is initially managed by endoscopic detorsion and placement of a flatus tube, which deflates the loop in most cases. Because recurrence rates approach 50 percent, elective sigmoid colectomy should be offered during the same admission in a fit patient. Emergency resection is reserved for suspected gangrene, perforation, or failed endoscopic decompression. Nasogastric decompression alone does not address the torsion.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.