Risk factors and surgical management of sigmoid volvulus among patients attending Al-Karama Teaching Hospital of Iraq

Abstract

Background: Sigmoid volvulus is defined as torsion of the sigmoid colon around its mesenteric axis, which leads to acute large intestine obstruction, which, if left untreated, often results in life-threatening complications, such as bowel ischemia, gangrene and perforation. The aim of this study was to analyse sigmoid colon volvulus when its presented as a surgical emergency.Methods: This was a prospective study of 25 patients presented with the features of strangulated sigmoid colon volvulus to Al-Karama Teaching Hospital (surgical casualty) from March 2014 to March 2018. Eighteen patients (72%) were males and seven patients (28%) were females. The age of the patients ranged from 20-70 years. The main risk factor was chronic constipation, laxative dependency and high fiber diet. The main presenting symptoms and signs were absolute constipation, generalized abdominal distension, tenderness, tachycardia and fever. The patients were investigated by plain abdominal X-ray and haematological investigations.Results: Among the 25 patients, 13 had distended gangrenous sigmoid colon volvulus, 9 out of the remaining 12 patients were discovered to have distended non-gangrenous sigmoid colon volvulus of the rest 3 patients, 2 were found to have Ileo-sigmoid knotting and the last patient had a perforated gangrenous sigmoid colon volvulus. Four patients developed postoperative complications and one patient died.Conclusions: Volvulus of the sigmoid colon is more predominant in males. Middle age individuals seem to be the most affected group by sigmoid colon volvulus. Majority of patients with sigmoid colon volvulus have history of chronic constipation, laxative dependency and high fiber diet.