In sigmoid volvulus, what is an acceptable initial management option when the patient is stable?

• A. Flexible sigmoidoscopy
• B. Laparotomy
• C. Colonoscopy with biopsy
• D. Appendectomy

Answer: (A)

When a patient with sigmoid volvulus is stable, the first step is nonoperative detorsion to relieve the obstruction. Using flexible sigmoidoscopy allows the clinician to pass a scope into the twisted sigmoid, untwist it, and decompress the bowel. This rapidly relieves symptoms without exposing the patient to the risks of open surgery, which is why it’s the preferred initial management in a stable patient.

Laparotomy is saved for situations where the patient is unstable, or there are signs of bowel ischemia, perforation, or failure of nonoperative detorsion. Colonoscopy with biopsy isn’t needed for this problem and carries unnecessary risks; biopsy doesn’t contribute to rapid decompression. Appendectomy isn’t relevant to addressing a sigmoid volvulus. After successful decompression, definitive surgical resection of the redundant sigmoid may be planned electively to prevent recurrence.