Which type of volvulus is most commonly treated with rectal tube insertion?

Which type of volvulus is most commonly treated with rectal tube insertion?

• A. Cecal
• B. Sigmoid
• C. Jejunoileal
• D. Transverse

Answer: (B)

Decompression with a rectal tube is most effective for sigmoid volvulus because the redundant sigmoid colon lies within reach of a rectal tube or flexible sigmoidoscope, allowing nonoperative detorsion and gas/stool relief. This approach is commonly successful as an initial step, often followed by planning definitive surgery to prevent recurrence. In contrast, cecal volvulus involves the proximal colon higher up and is not amenable to rectal decompression, typically needing surgical detorsion or resection. Jejunoileal and transverse volvulus involve the small bowel or more proximal segments where endoscopic rectal decompression isn’t feasible, and these usually require operative management due to risk of ischemia or perforation.

Decompression with a rectal tube is most effective for sigmoid volvulus because the redundant sigmoid colon lies within reach of a rectal tube or flexible sigmoidoscope, allowing nonoperative detorsion and gas/stool relief. This approach is commonly successful as an initial step, often followed by planning definitive surgery to prevent recurrence. In contrast, cecal volvulus involves the proximal colon higher up and is not amenable to rectal decompression, typically needing surgical detorsion or resection. Jejunoileal and transverse volvulus involve the small bowel or more proximal segments where endoscopic rectal decompression isn’t feasible, and these usually require operative management due to risk of ischemia or perforation.