Emergency Management of Sigmoid Colon Volvulus in a Volvulus Belt Population and a Review of Literature

Abstract

Algorithm for management of acute sigmoid volvulus is still controversial. This study was undertaken in a volvulus belt population emphasizing on emergency resection and primary anastomosis without on-table colonic irrigation or diversion. Four hundred forty-five acute sigmoid volvulus patients were reviewed retrospectively. Records of 366 operated patients were studied thoroughly. After operative detorsion and simple decompression, resection and primary anastomosis without a diverting stoma with postoperative anal dilatation were done in those who obeyed certain criteria; the rests were subjected for alternative operations. Ileal resection anastomosis was added in compound volvulus cases. Literature was reviewed. Epidemiology: constitutes 40.4% of small and large intestinal and 87.8% of large intestinal obstruction cases; maximum of 40–60 years with slight male preponderance. Operated: 148 gangrenous, 10 compound, 3 perforated, and 205 uncomplicated patients—mesocoloplasty in 2; resection with primary anastomosis in 270 including 60 gangrenous, 6 compound, and 1 perforated; 92 Hartmann’s procedure and 2 Paul Mickulicz in other gangrenous cases. Mortality: with primary anastomosis 7.4% with no significant difference between gangrenous and non-gangrenous groups; with no restoration of continuity 19.2% and overall 7.5% without gangrene, 14.3% with gangrene and 10.4% in an average; in reducing trend with ICU facility. There was no death with compound volvulus. Morbidity with primary anastomosis: 5.9% anastomotic leak, 9.6% wound infection, and 1% wound dehiscence. Emergency resection and primary anastomosis after decompression without on-table lavage are safe procedures in developing nations in patients who are stable at presentation or after resuscitation having favorable intraoperative criteria.