INTRODUCTION: Sigmoid volvulus is a common surgical emergency in many regions of the world, with significant morbidity and mortality. The aims of this study were to (a) summarize outcomes and (b) define a treatment algorithm for sigmoid volvulus in our setting. EXPERIMENTAL: Five year (2003-2008) retrospective review of sigmoid volvulus cases at Kamuzu Central Hospital, in Lilongwe, Malawi. RESULTS AND DISCUSSION: There were 239 cases of sigmoid volvulus identified. Cases were mostly seen in males (91.7%), with a median age of 50 (range 18-86). Gangrene was noted in 36.7% of cases. Mesosigmoidopexy (36%), Hartmann's procedure (33%), and resection and anastomosis (23%) were the most common procedures. There was seasonal variation with more cases seen in the harvest months of March and April. The major complications noted were recurrence (5 of 6 recurrences after mesosigmoidopexy / plasty) and anastomotic leakage after resection and anastomosis (2 in gangrenous, and 2 in non-gangrenous sigmoid volvulus). CONCLUSIONS: Gangrenous sigmoid volvulus is best managed with Hartmann's procedure. Non-gangrenous sigmoid volvulus is best managed with resection and anastomosis, unless there are risk factors for anastomotic leakage, in which case the surgeon should consider mesosigmoidopexy with non-absorbable suture.
INTRODUCTION:Sigmoid volvulus is a common surgical emergency in many regions of the world, with significant morbidity and mortality. The aims of this study were to (a) summarize outcomes and (b) define a treatment algorithm for sigmoid volvulus in our setting. EXPERIMENTAL: Five year (2003-2008) retrospective review of sigmoid volvulus cases at Kamuzu Central Hospital, in Lilongwe, Malawi. RESULTS AND DISCUSSION: There were 239 cases of sigmoid volvulus identified. Cases were mostly seen in males (91.7%), with a median age of 50 (range 18-86). Gangrene was noted in 36.7% of cases. Mesosigmoidopexy (36%), Hartmann's procedure (33%), and resection and anastomosis (23%) were the most common procedures. There was seasonal variation with more cases seen in the harvest months of March and April. The major complications noted were recurrence (5 of 6 recurrences after mesosigmoidopexy / plasty) and anastomotic leakage after resection and anastomosis (2 in gangrenous, and 2 in non-gangrenous sigmoid volvulus). CONCLUSIONS:Gangrenous sigmoid volvulus is best managed with Hartmann's procedure. Non-gangrenous sigmoid volvulus is best managed with resection and anastomosis, unless there are risk factors for anastomotic leakage, in which case the surgeon should consider mesosigmoidopexy with non-absorbable suture.
Authors: A Vignali; V W Fazio; I C Lavery; J W Milsom; J M Church; T L Hull; S A Strong; J R Oakley Journal: J Am Coll Surg Date: 1997-08 Impact factor: 6.113
Authors: Niels van der Naald; Marloes I Prins; Kars Otten; Dayson Kumwenda; Robert P Bleichrodt Journal: World J Surg Date: 2018-06 Impact factor: 3.352
Authors: Ahmet Surek; Cevher Akarsu; Eyup Gemici; Sina Ferahman; Ahmet Cem Dural; Mehmet Abdussamet Bozkurt; Turgut Donmez; Mehmet Karabulut; Halil Alis Journal: Int J Colorectal Dis Date: 2021-01-29 Impact factor: 2.571