In a 90-year-old man with sigmoid volvulus presenting with peritonitis, what is the next step in management?

In a 90-year-old man with sigmoid volvulus presenting with peritonitis, what is the next step in management?

• A. Exploratory laparotomy
• B. Endoscopic detorsion
• C. Flexible sigmoidoscopy
• D. Observation with supportive care

Answer: (C)

When sigmoid volvulus presents with peritonitis, the priority is to go straight to urgent surgical exploration. Peritonitis signals possible bowel ischemia or perforation, so delaying for nonoperative detorsion or observation risks ongoing sepsis and widespread necrosis. Endoscopic detorsion or flexible sigmoidoscopy can decompress in stable patients without peritoneal signs, but they do not address perfedation or nonviable bowel and would delay definitive treatment. Observation is inappropriate because the infection and potential infarction require immediate operative management. During exploratory laparotomy, the surgeon assesses bowel viability and resec ts nonviable segments, with the option of primary anastomosis or a stoma depending on contamination and patient condition.

When sigmoid volvulus presents with peritonitis, the priority is to go straight to urgent surgical exploration. Peritonitis signals possible bowel ischemia or perforation, so delaying for nonoperative detorsion or observation risks ongoing sepsis and widespread necrosis. Endoscopic detorsion or flexible sigmoidoscopy can decompress in stable patients without peritoneal signs, but they do not address perfedation or nonviable bowel and would delay definitive treatment. Observation is inappropriate because the infection and potential infarction require immediate operative management. During exploratory laparotomy, the surgeon assesses bowel viability and resec ts nonviable segments, with the option of primary anastomosis or a stoma depending on contamination and patient condition.