immediate management: once the diagnosis has been made then a sigmoidoscopy is performed and a large-bore flatus tube passed into the volvulus. If the procedure is successful, then there is a gush of liquid faeces and flatus as the obstruction is relieved. The tube can be left in-situ for 24 hours to discourage further twisting of the bowel, maintain decompression, and allow recovery of the vascular supply. If this procedure does not resolve the condition then emergency surgery and laparotomy may be required.
management of gangrene: if gangrene is suspected, e.g. from the physical signs or the appearance of a discoloured mucosa on endoscopy, then immediate laparotomy and resection is required. The distended bowel should be deflated first by direct puncture. A Hartmann's or Paul-Mikulicz procedure is then carried out.
further management: patient is put on a high fibre diet and their medication is reviewed
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