A 78-year-old woman presents with gross abdominal distension of two days' duration. Radiographs show a massively dilated loop arising from the pelvis toward the right upper quadrant with a 'coffee bean' appearance. She is haemodynamically stable, there is no fever or peritonism, and bowel sounds are active. What is the correct next step in management?

• A Immediate emergency laparotomy and resection
• B Flexible sigmoidoscopy with insertion of a flatus tube for detorsion ✓
• C Contrast enema as definitive treatment
• D Nasogastric decompression and observation alone

Explanation

Sigmoid volvulus without features of gangrene or perforation is initially managed by endoscopic detorsion using a rigid or flexible sigmoidoscope, with a flatus tube left in situ to prevent immediate re-twisting. Because recurrence rates are very high, elective sigmoid colectomy should be offered during the same admission in a fit patient. Laparotomy is reserved for suspected ischaemia or perforation, and contrast enema is obsolete as definitive therapy.

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.