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Manual evacuation of rectal impaction
41%
36/87
Administer large doses of laxatives
7%
6/87
Laparotomy with sigmoid resection
17%
15/87
Proctosigmoidoscopy and placement of a rectal tube
29%
25/87
Observation
5%
4/87
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This patient's clinical presentation is consistent with sigmoid volvulus. The first-line treatment for this condition is proctosigmoidoscopy and placement of rectal tube. Elderly patients presenting with abdominal pain and constipation should be evaluated for volvulus. On barium enema radiograph, sigmoid volvulus is associated with a "parrot's beak" sign, which is characterized by a gas shadow in the right upper quadrant that tapers towards the left lower quadrant. The mortality rate for sigmoid volvulus is up to 45%, usually resulting from delayed diagnosis. Figure/Illustration A shows a barium enema radiograph typical of a sigmoid volvulus, with notable parrot's beak sign (yellow arrow). Incorrect Answers: Answer 1: This is the treatment for rectal impaction, which does not present with a parrot beak sign on X-ray. Answer 2: Regular use of laxatives is associated with a higher risk of sigmoid volvulus, and acute laxative treatment is not thought to be beneficial in patients with a sigmoid volvulus. Answer 3: Laparotomy with sigmoid resection should be performed either electively after decompression or in the case of unsuccessful decompression. Answer 5: This patient's condition carries up to a 40% mortality rate, and her bowel should be decompressed immediately.
5.0
(4)
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