An 80-year-old man who has been bedridden for many years following a stroke presents with acute onset of abdominal distention, obstipation, and colicky abdominal pain. Abdominal x-rays reveal dilated loops of small bowel and a dilated sigmoid colon resembling a bent inner tube. Examination reveals distention with mild direct tenderness but no rigidity or rebound tenderness. Initial management should consist of:
A. Barium enema examination.
B. Laparotomy with resection of descending colon and descending colostomy.
C. Multiple cleansing enemas to remove impacted feces.
D. Rigid sigmoidoscopy and decompression of the sigmoid colon.
Answer:D
An 80-year-old man who has been bedridden for many years following a stroke presents with acute onset of abdominal distention, obstipation, and colicky abdominal pain. Abdominal x-rays reveal dilated loops of small bowel and a dilated sigmoid colon resembling a bent inner tube. Examination reveals distention with mild direct tenderness but no rigidity or rebound tenderness. Initial management should consist of:
A. Barium enema examination. B. Laparotomy with resection of descending colon and descending colostomy. C. Multiple cleansing enemas to remove impacted feces. D. Rigid sigmoidoscopy and decompression of the sigmoid colon.