Insert nasogastric tube if the patient has been vomiting. Intravascular volume usually is depleted and early intravenous fluid resuscitation with isotonic saline or Ringer lactate solution is necessary. Initial therapy is directed at patient comfort and volume resuscitation with the ultimate goal to decompress the large intestine. Obtain early consultation from a general surgeon, because surgical intervention frequently is indicated depending on the cause of the obstruction. Sigmoid volvulus First choice is sigmoidoscopy with volvulus reduction.
Second choice is sigmoid colectomy.
Cecal volvulus First choice is hemicolectomy. Second choice is colonoscopy. Sigmoid obstruction secondary to diverticulitis or carcinoma Procedure of choice is a sigmoid resection and Hartman procedure or a sigmoid resection. Alternative is primary anastomosis. First choice is extended hemicolectomy.