An 82-year-old female nursing home resident is admitted with massive abdominal distension and constant abdominal pain with diffuse tenderness. Abdominal x-ray shows a massively distended loop of colon with a characteristic “bent inner tube” appearance. The management of this patient should include:
A.	Urgent laparotomy because of the massive colon distension
B.	An attempt at endoscopic decompression with a flexible sigmoidoscope
C.	Elective laparotomy and sigmoid resection should follow if endoscopic decompression is successful
D.	If at urgent laparotomy resected bowel is present, colon resection with primary anastomosis is in order
Answer:B
An 82-year-old female nursing home resident is admitted with massive abdominal distension and constant abdominal pain with diffuse tenderness. Abdominal x-ray shows a massively distended loop of colon with a characteristic “bent inner tube” appearance. The management of this patient should include:
A.	Urgent laparotomy because of the massive colon distension B.	An attempt at endoscopic decompression with a flexible sigmoidoscope C.	Elective laparotomy and sigmoid resection should follow if endoscopic decompression is successful D.	If at urgent laparotomy resected bowel is present, colon resection with primary anastomosis is in order