A 70-year-old man with chronic constipation presents with sudden abdominal distension, absolute constipation, and vomiting of 24 hours duration. The abdomen is grossly distended and tympanitic but soft, with no peritonism. Plain abdominal radiograph shows a massively dilated loop arising from the pelvis with a coffee bean appearance. What is the most appropriate next step in management?
- A Emergency laparotomy with sigmoid colectomy and primary anastomosis
- B Rigid sigmoidoscopy with insertion of a flatus tube for decompression ✓
- C Water-soluble contrast enema followed by outpatient review
- D CT-guided percutaneous decompression of the sigmoid loop
Correct answer: B. Rigid sigmoidoscopy with insertion of a flatus tube for decompression
Explanation
In uncomplicated sigmoid volvulus, confirmed clinically by absence of fever, tachycardia, and peritonism, endoscopic detorsion with passage of a flatus tube is the accepted first-line treatment and achieves decompression in most cases. Because recurrence rates are high, elective sigmoid colectomy should be discussed afterwards. Emergency resection is reserved for suspected gangrene, perforation, or failed endoscopic decompression. Percutaneous decompression has no established role.
Reference: Bailey and Love Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.