A 72-year-old woman presents with sudden abdominal distension and absolute constipation. Abdominal radiograph shows a grossly dilated loop arising from the pelvis with the classic coffee bean sign. CT confirms sigmoid volvulus without signs of ischaemia or perforation. She is haemodynamically stable. What is the correct initial management?

• A Emergency sigmoid colectomy with primary anastomosis
• B Caecostomy tube insertion
• C Endoscopic detorsion alone with discharge and outpatient follow-up
• D Endoscopic detorsion and decompression followed by elective sigmoid colectomy during the same admission ✓

Explanation

In uncomplicated sigmoid volvulus, endoscopic detorsion and decompression resolves the acute episode in most patients and allows resuscitation and bowel preparation. Because recurrence rates exceed 50 percent without definitive surgery, elective sigmoid colectomy should be performed during the same admission. Emergency resection is reserved for gangrene, perforation or failed endoscopic reduction. Detorsion alone carries a very high recurrence rate, and caecostomy has no role in sigmoid volvulus.

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

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Written and medically reviewed by the StethoPrep medical team.