A 75-year-old man presents with acute abdominal distension and pain. Abdominal X-ray shows a 'coffee bean' sign pointing toward the right upper quadrant. Rigid sigmoidoscopy confirms the diagnosis of sigmoid volvulus. The abdomen is soft and non-tender. What is the next step in management?

• A Emergency laparotomy with sigmoid colectomy
• B Colonoscopic detorsion and rectal tube placement ✓
• C Barium enema reduction
• D Conservative management with IV fluids and electrolytes

Explanation

In sigmoid volvulus without peritonitis or perforation, initial management is endoscopic detorsion with a flexible sigmoidoscope and placement of a rectal tube. This achieves decompression in the majority of cases. Because recurrence rates exceed 50% after non-operative reduction, elective sigmoid colectomy is recommended during the same admission if the patient is a surgical candidate.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.