A 78-year-old man presents with sudden abdominal distension and absolute constipation. Abdominal radiograph shows a massively dilated loop arising from the pelvis with its apex under the left hemidiaphragm (coffee bean sign). Flexible sigmoidoscopic decompression is successful. What is the definitive next step in management?
- A Repeat sigmoidoscopic decompression only when recurrence occurs
- B Elective sigmoid colectomy during the same admission ✓
- C Long term stool softeners and dietary fibre alone
- D Percutaneous endoscopic colostomy as definitive treatment
Correct answer: B. Elective sigmoid colectomy during the same admission
Explanation
Sigmoid volvulus is initially decompressed endoscopically, but recurrence rates after decompression alone are very high (reported between 40 and 90 percent), so elective segmental resection of the redundant sigmoid should be offered during the same admission once the patient is resuscitated and fit. Repeated decompression alone leaves the patient exposed to life threatening strangulation and gangrene. Percutaneous colostomy is reserved for patients unfit for any operation.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.