A 68-year-old man presents with sudden massive abdominal distension and absolute constipation for two days. He is hemodynamically stable with mild tenderness and no peritonism. Abdominal radiograph shows a grossly dilated loop arising from the pelvis with a coffee bean appearance. What is the most appropriate immediate management?

• A Emergency laparotomy and sigmoid colectomy
• B Nasogastric decompression and observation alone
• C Barium enema for reduction
• D Endoscopic detorsion and decompression via flexible sigmoidoscopy ✓

Explanation

In sigmoid volvulus without perforation, gangrene or peritonitis, the standard first step is endoscopic detorsion and placement of a flatus tube, which succeeds in most cases. Because recurrence occurs in up to 90 percent of patients after decompression alone, elective sigmoid colectomy is planned in the same admission once the patient is optimized. Emergency laparotomy is reserved for suspected gangrene, perforation or failed endoscopic reduction, and barium enema has been abandoned due to perforation risk.

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.