What is the preferred initial treatment for sigmoid volvulus in a patient without sepsis or bowel necrosis?

• A. Broad-spectrum antibiotics
• B. Immediate surgery
• C. Flexible sigmoidoscopy
• D. Nasogastric decompression

Answer: (C)

When sigmoid volvulus occurs but the patient is stable and there are no signs of sepsis or bowel necrosis, the first step is to relieve the twist by decompressing the colon. Flexible sigmoidoscopy allows you to rapidly untwist the dialed loop and decompress the bowel, which both resolves the acute obstruction and reduces the risk of ischemia. After detorsion, a rectal tube is often placed and definitive surgical resection of the redundant sigmoid is planned electively to prevent recurrence.

Broad-spectrum antibiotics are reserved for infection or perforation, not needed for uncomplicated obstruction. Nasogastric decompression helps with gastric decompression but does not correct the sigmoid twist. Immediate surgery is indicated only if there are signs of peritonitis, sepsis, or intestinal necrosis, or if endoscopic detorsion fails.