A 72-year-old man presents with 2 days of massive abdominal distension and obstipation. Plain radiograph shows a grossly dilated loop arising from the pelvis with a coffee-bean appearance. On examination he has generalised guarding, rigidity, and a temperature of 38.5 degrees Celsius. What is the most appropriate next step?
- A Rigid sigmoidoscopy and endoscopic decompression
- B Barium enema for reduction
- C Emergency laparotomy with sigmoid colectomy ✓
- D Nasogastric decompression and observation
Correct answer: C. Emergency laparotomy with sigmoid colectomy
Explanation
Sigmoid volvulus is managed by endoscopic detorsion only when the bowel is viable. Generalised peritonitis, rigidity, and fever indicate gangrene or perforation, so endoscopic decompression risks perforating dead bowel and delays definitive treatment. Emergency laparotomy with resection of the necrotic sigmoid is indicated. Barium enema is contraindicated when perforation is suspected because extravasation of barium worsens peritonitis.
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.