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Recurrent sigmoid volvulus after successful endoscopic detorsion — MRCEM SBA MCQ

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HardGastrointestinal and surgical emergenciesRecurrent sigmoid volvulus after successful endoscopic detorsionMRCEM SBA

A 71-year-old woman presents with abdominal pain, distension and failure to pass stool or flatus. She underwent endoscopic decompression of sigmoid volvulus four weeks ago but did not have definitive surgery. CT confirms recurrent sigmoid volvulus without perforation or features of bowel ischaemia. Following intravenous fluids, flexible sigmoidoscopy successfully detorses the bowel; the mucosa appears viable and a rectal tube is placed. Her symptoms resolve, she remains haemodynamically stable and has no peritonism. She is independent, has no major comorbidity and is considered fit for colorectal surgery. What is the most appropriate subsequent plan?

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Correct answer: D — Admit for sigmoid colectomy during this admission after perioperative assessment.

Successful detorsion has relieved the acute obstruction. Viable mucosa, clinical improvement and the absence of peritonism mean that immediate resection is not indicated. Decompression does not, however, prevent another volvulus: this patient has already had an early recurrence and is fit for definitive surgery. The best plan is colorectal admission for sigmoid colectomy after perioperative assessment, during this admission. NICE describes surgery as a means of preventing recurrence, particularly after repeated episodes, and UK clinical studies support consideration of early definitive surgery following decompression. ([nice.org.uk](https://www.nice.org.uk/guidance/htg105/resources/percutaneous-endoscopic-colostomy-pdf-1809587462439877)) A leaves the recurrent condition untreated. B recognises the need for resection but exposes her to a further interval of recurrence before an operation that can be planned during this admission. C is a plausible alternative for recurrent volvulus when conventional surgery is unsuitable; NICE particularly supports its use in frail patients, unlike this surgically fit woman. E would be considered if there were failed detorsion, perforation, peritonitis or non-viable bowel. None is present here, and an immediate operation with end colostomy is not justified by recurrence alone. ([nice.org.uk](https://www.nice.org.uk/guidance/htg105/chapter/1-Recommendations))

Reference: NICE HTG105: Percutaneous endoscopic colostomy, section 2.1 (22 March 2006) — https://www.nice.org.uk/guidance/htg105/resources/percutaneous-endoscopic-colostomy-pdf-1809587462439877 NICE HTG105: Percutaneous endoscopic colostomy, recommendation 1.1 (22 March 2006) — https://www.nice.org.uk/guidance/htg105/chapter/1-Recommendations Ambiguities in Sigmoid Volvulus Management: Developing a Framework for Optimal Management Strategies (7 December 2025) — https://pubmed.ncbi.nlm.nih.gov/41503295/