A 72-year-old man presents with sudden abdominal distension, absolute constipation, and vomiting. Abdominal radiograph shows a grossly dilated loop arising from the pelvis with its apex pointing toward the right upper quadrant, giving a coffee bean appearance. He is haemodynamically stable with no peritonism. What is the immediate next step?

• A Emergency laparotomy and sigmoid colectomy
• B Barium enema for reduction
• C CT-guided percutaneous caecostomy
• D Flexible sigmoidoscopic decompression with insertion of a flatus tube ✓

Explanation

The coffee bean loop rising out of the pelvis is classic sigmoid volvulus. In a stable patient without signs of gangrene or perforation, endoscopic detorsion and decompression with a rectal tube is the accepted first step, followed by elective sigmoid colectomy during the same admission because recurrence rates approach 50 percent. Emergency surgery is reserved for suspected ischaemia, perforation, or failed endoscopic decompression.

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.