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

Abstract

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