An 80-year-old man presents with sudden abdominal distension and absolute constipation. Plain radiograph shows a massively dilated loop arising from the pelvis with a coffee bean appearance. After resuscitation, flexible sigmoidoscopy confirms sigmoid volvulus with viable mucosa and successful detorsion is performed. What is the definitive next step?
- A Discharge with dietary advice and follow-up radiographs every 6 months
- B Elective sigmoid colectomy during the same admission ✓
- C Repeat sigmoidoscopic decompression whenever recurrence occurs
- D Percutaneous endoscopic colostomy as definitive fixation
Correct answer: B. Elective sigmoid colectomy during the same admission
Explanation
Endoscopic decompression resolves about 80 percent of sigmoid volvulus cases, but recurrence approaches 50 percent without resection, so elective sigmoid colectomy should be offered once stabilised, ideally during the same admission. Repeat decompression alone accepts a high mortality risk from future strangulation. Percutaneous colostomy is reserved for patients unfit for laparotomy. Emergency colectomy is indicated only if decompression fails or gangrene is suspected.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.