Gastroenterology and hepatology: sigmoid volvulus: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology and hepatology: sigmoid volvulus

Sample item

A 78-year-old nursing home resident with chronic constipation has abdominal distension and absolute constipation. Radiograph shows a hugely dilated loop shaped like a coffee bean, arising from the pelvis. There is no peritonitis. What is the first-line management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Endoscopic decompression with a rectal tube

Sigmoid volvulus is common in elderly, constipated and institutionalised patients. If there are no signs of strangulation or perforation, sigmoidoscopic detorsion with a flatus tube is the first step, and elective sigmoid resection follows because recurrence is common.

Option by option

  • A. Emergency Hartmann procedure

    A Hartmann procedure is reserved for gangrene or perforation.

  • B. Endoscopic decompression with a rectal tube (correct)

    Correct. Sigmoidoscopic detorsion relieves the obstruction without emergency surgery.

  • C. Right hemicolectomy

    Right hemicolectomy treats a right-sided lesion and not a sigmoid twist.

  • D. Intravenous neostigmine

    Neostigmine treats colonic pseudo-obstruction, not a mechanical twist.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Endoscopic decompression with a rectal tube. Sigmoid volvulus is common in elderly, constipated and institutionalised patients.

Why is "Emergency Hartmann procedure" not the answer?

A Hartmann procedure is reserved for gangrene or perforation.

Why is "Right hemicolectomy" not the answer?

Right hemicolectomy treats a right-sided lesion and not a sigmoid twist.

Why is "Intravenous neostigmine" not the answer?

Neostigmine treats colonic pseudo-obstruction, not a mechanical twist.

What concept does this question test?

It tests Gastroenterology and hepatology: sigmoid volvulus in General Medicine. If there are no signs of strangulation or perforation, sigmoidoscopic detorsion with a flatus tube is the first step, and elective sigmoid resection follows because recurrence is common.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology and hepatology: sigmoid volvulus?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.