Sigmoid volvulus and ileo-sigmoid knotting: a five-year experience at a tertiary care hospital in Tanzania

World Journal of Emergency Surgery

Joseph B Mabula¹  Phillipo L Chalya¹ 

[1] Department of Surgery, Catholic University of Health and Allied Science-Bugando, Mwanza, Tanzania

关键词: Tanzania;    Outcome;    Management;    Clinical presentation;    Sigmoid volvulus;   

Others  :  1140095
DOI  :  10.1186/s13017-015-0001-1

 received in 2015-01-10, accepted in 2015-01-26,  发布年份 2015

【 摘 要 】

Background

Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people compared to developed countries. No prospective study has been done on this subject in Tanzania and Bugando Medical Centre in particular. This study describes in our region, the clinical presentation, management and outcome of sigmoid volvulus.

Methods

This was a descriptive prospective study of patients operated for sigmoid volvulus at Bugando Medical Centre from March 2009 to February 2014.

Results

A total of 146 patients (M: F = 5.1: 1) representing 14.2% of all cases of bowel obstruction were studied. The median age at presentation was 48 years. The disease significantly affected the older males compared with females (P = 0.012). The majority of the patients 102, (93.2%) presented acutely and had to undergo emergency surgical intervention, the rest were either sub-acute or chronic. Out of the 146 patients studied, 24 (16.4%) had ileo-sigmoid knotting. The majority of patients, 102(69.9%) were treated with resection and primary anastomosis, of which 63.0% were emergency cases. Colostomy was offered to 30.1% of cases. No patient had sigmoidoscopic derotation. Complications mainly surgical site infections were reported in 20.5% of cases. The overall median length of hospital stay was 14 days. Overall mortality rate was 17.1%. The main predictors of mortality were advanced age (>60 years), concomitant medical illness, late presentation (≥24 hours), presence of shock on admission and presence of gangrenous bowel (P < 0.001). The follow up of patients in this study was generally poor as more than half of patients were lost to follow up.

Conclusion

Sigmoid volvulus is not uncommon in our setting and commonly affects males than females. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. Findings from this study suggest that in viable bowel, sigmoid resection and primary anastomosis is feasible as it may not adversely affect outcome. Temporary colostomy should be considered if the bowel is gangrenous or perforated. Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease.

【 授权许可】

   
2015 Chalya and Mabula; licensee BioMed Central.

【 参考文献 】

• [1]Avots-Avotins KV, Waugh DE: Colon volvulus and the geriatric patient. Surg Clin North Am 1982, 62:248-60.
• [2]Katsikogiannis N, Machairiotis N, Zarogoulidis P, Sarika E, Stylianaki A, Zisoglou M, et al.: Management of sigmoid volvulus avoiding sigmoid resection. Case Rep Gastroenterol 2012, 6:293-9.
• [3]Raveenthiran V: Observations on the pattern of vomiting and morbidity in patients with acute sigmoid volvulus. J Postgrad Med 2004, 50:27-9.
• [4]Lal SK, Morgenstern R, Vinjirayer EP, Matin A: Sigmoid volvulus an update. Gastrointest Endosc Clin N Am 2006, 16(1):175-87.
• [5]Onder A, Kapan M, Arikanoglu Z, Palanci Y, Gumus M, Aliosmanoglu I, et al.: Sigmoid colon torsion: mortality and relevant risk factors. Eur Rev Med Pharmacol Sci 2013, 1:127-32.
• [6]Akinkuotu A, Samuel JC, Msiska N, Mvula C, Charles AG: The role of the anatomy of the sigmoid colon in developing sigmoid volvulus: a case-control study. Clin Anat 2011, 24:634-7.
• [7]Raveenthiran R, Madiba TE, Atamanalp SS, De U: Volvulus of the sigmoid colon. Colorectal Dis 2010, 12:1-17.
• [8]Bhatnagar BN, Sharma CL, Gupta SN, Mathur MM, Reddy DCS: Study on the anatomical dimensions of the human sigmoid colon. Clin Anat 2004, 17:236-43.
• [9]Madiba TE, MR H a, Sikhosana MH: Radiological anatomy of the sigmoid colon. Surg Radiol Anat 2008, 30:409-15.
• [10]Atamanalp SS, Yildirgan MI, Basoglu M, Kantarci M, Yilmaz I: Sigmoid colon volvulus in children: review of 19 cases. Pediatr Surg Int 2004, 20:492-5.
• [11]Sule AZ, Ajibade A: Adult large bowel obstruction: a review of clinical experience. Ann Afr Med 2011, 10:45-50.
• [12]Khan M, Ullah S, Jan MAU, Naseer A, Ahmed S, Rehman A: Primary anastomosis in the management of acute sigmoid volvulus with out colonic lavage. J Postgrad Med Inst 2007, 21:305-8.
• [13]Kotisso B, Bekele A: A three-year comprehensive retrospective analysis of Ilio-sigmoid knotting in Addis Ababa. Ethiop Med 2006, 44:377-83.
• [14]Okello TR, Ogwang DM, Kisa P, Komagum P: Sigmoid volvulus and ileosigmoid knotting at St. Mary’s Hospital Lacor in Gulu, Uganda. East Cent Afr J Surg 2009, 14:58-64.
• [15]Sule AZ, Misauna M, Opaluwa AS, Ojo E, Obekpa PO: One stage procedure in the management of acute sigmoid volvulus without colonic lavage. Surgeon 2007, 5(5):268-70.
• [16]Akcan A, Akyildiz H, Artis T, Yilmaz N, Sozuer E: Feasibility of single-stage resection and primary anastomosis in patients with acute noncomplicated sigmoid volvulus. Am J Surg 2007, 193:421-6.
• [17]Atamanalp SS, Ören D, Aydınlı B, Öztürk G, Polat KY, Başoğlu M: Elective treatment of detorsioned sigmoid volvulus. Turk J Med Sci 2008, 38:227-34.
• [18]Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Başoğlu M, Polat KY: An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum 2007, 50:489-97.
• [19]Atamanalp SS: Sigmoid volvulus. EAJM 2010, 42:142-7.
• [20]Roseano M, Guarino G, Culviello A: Sigmoid volvulus: diagnostic and therapeutic features (considerations on 10 cases). Ann Ital Chir 2001, 72:79-84.
• [21]Bhuiyan MM, Machowski ZA, Linyama BS, Madiba MC: Management of sigmoid volvulus in Polokwane-Mankweng Hospital. Afr J Surg 2005, 43:17-9.
• [22]Wolters U, Wolf T, Stutzer H, Schroder T: ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996, 77:217-22.
• [23]Jumbi G, Kuremu RT: Emergency resection of sigmoid volvulus. East Afr Med J 2008, 85:398-405.
• [24]Berry AR: Oxford Textbook of surgery. Volvulus of colon 2nd edition. 2000, 1515-9.
• [25]Lou Z, Yu ED, Zhang W, Meng RG, Hao LQ, Fu CG: Appropriate treatment of acute sigmoid volvulus in the emergency setting. World J Gastroenterol 2013, 19:4979-83.
• [26]Khanna AK, Kumar P, Khanna R: Sigmoid volvulus: study from a north Indian hospital. Dis Colon Rectum 1999, 42:1081-4.
• [27]Bac B, Aldemir M, Tacyildiz I, Keles C: Predicting factors for mortality in sigmoid volvulus. Dicle Med J 2004, 31:9-15.
• [28]Atamanalp SS, Ozturk G: Sigmoid volvulus in the elderly: outcomes of a 43-year, 453-patient experience. Surg Today 2011, 41:514-9.
• [29]Osiro SB, Cunningham D, Shoja MM, Tubbs RS, Gielecki J, Loukas M: The twisted colon: a review of sigmoid volvulus. Am Surg 2012, 78:271-9.
• [30]Burrell HC, Baker DM, Wardrop P, Evans AJ: Significant plain film findings in sigmoid volvulus. Clin Radiol 1994, 49:317-9.
• [31]Hirao K, Kikawada M, Hanyu H, Iwamoto T: Sigmoid volvulus showing “a whirl sign” on CT. Intern Med 2006, 45:331-2.
• [32]Atamanalp SS, Oren D, Basoglu M, Yildirgan MI, Balik AA, Polat KY, et al.: Ileosigmoidal knotting: outcome in 63 patients. Dis Colon Rectum 2004, 47:906-10.
• [33]Mulas C, Bruna M, García-Armengol J, Roig JV: Management of colonic volvulus. Experience in 75 patients. Rev Esp Enferm Dig 2010, 102:239-48.
• [34]Bruusgaard C: Volvulus of the sigmoid colon and its treatment. Surgery 1947, 22:466-78.
• [35]Nuhu A, Jah A: Acute sigmoid volvulus in a West African population. Ann Afr Med 2010, 9:86-90.
• [36]Liang JT, Lai HS, Lee PH: Elective laparoscopically assisted sigmoidectomy for the sigmoid volvulus. Surg Endosc 2006, 20:1772-3.
• [37]Madiba TE, Thomson SR: The management of sigmoid volvulus. J R Coll Surg Edinb 2000, 45:74-80.