A 78-year-old man presents with sudden abdominal distension and absolute constipation. Abdominal radiograph shows a grossly dilated loop arising from the pelvis with a coffee-bean appearance. He has no fever, tachycardia, or peritonism. What is the most appropriate next step?
- A Flexible sigmoidoscopy with attempted detorsion and decompression ✓
- B Emergency laparotomy with sigmoid colectomy
- C Water-soluble contrast enema followed by outpatient follow-up
- D Nasogastric decompression and intravenous fluids only
Correct answer: A. Flexible sigmoidoscopy with attempted detorsion and decompression
Explanation
Uncomplicated sigmoid volvulus without signs of ischemia, perforation, or peritonitis is initially managed by endoscopic detorsion and decompression via flexible sigmoidoscopy, which succeeds in most cases. Because recurrence rates approach 40 to 50 percent, elective sigmoid colectomy should be offered during the same admission in fit patients. Emergency laparotomy is reserved for suspected gangrene, perforation, or failed 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.