Incidence and Factors Influencing the Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study

Abstract

Introduction: Sigmoid volvulus (SV) is one of the commonest causes of intestinal obstruction in Uganda. The purpose of this study was to determine the incidence and the factors influencing the outcome of management of SV in Northern Uganda. Methodology: This study had two parts. The retrospective study was to determine the incidence over a period of 2 years. In the one year prospective study to determine the factors influencing outcome, patients 13-years and above with SV were included and followed up to the 30th postoperative day. Ethical approval was obtained from the IRB of Gulu University. Data analysis was carried out using STATA/IC version 12.1. The outcome events were uneventful recovery, morbidity and mortality. Results: The incidence of SV in Northern Uganda was 251.8 per 100,000 surgical population in 2 years. Data on 103 patients were analyzed; 18 (17.48%) patients developed complications including wound sepsis 10 (9.7%); wound dehiscence 8(7.7%) and anastomotic leak 8(7.7%). There were 8 deaths, giving a mortality rate of 7.7%. The factors associated with a high risk of adverse outcome were hypernatraemia (RR=14.9; 95% CI: 1.46-152.9) and ileo-sigmoid knotting (RR = 4.94; 95% CI: 1.3018.78). Resection and primary anastomosis had a better outcome compared to Hartmann’s procedure (RR=0.15; 95% CI: 0.02-0.099). Conclusions: The incidence of SV in Northern Uganda was 251.8 per 100,000 surgical population in 2 years. The risk factors associated with morbidity and mortality were preoperative hypernatraemia and ileo-sigmoid knotting. Colostomy was associated with a higher risk of morbidity and mortality than resection and primary anastomosis.