Management of sigmoid volvulus in Polokwane-Mankweng Hospital.

OBJECTIVE To evaluate the outcome of treatment of patients with sigmoid volvulus in the Polokwane-Mankweng Hospital and to identify the best management options for these patients. METHODS A retrospective study was undertaken of 85 patients with sigmoid volvulus treated in Polokwane-Mankweng Hospital during the period July 1997-May 2004. RESULTS In total, 85 patients were evaluated (77 males and 8 females, male/female ratio 9:1). The age range was 7-80 years (mean 42 years). Sigmoidoscopic derotation was attempted in 17 patients, and was successful in 10 patients. Laparotomy was done in 84 patients, viz. 75 emergencies and 9 electives. During laparotomy, gangrenous sigmoid colon was found in 30 patients and viable sigmoid in 54 patients. Resection with primary anastomosis was done in 44 patients. Hartmann's procedure was performed in 33 patients. Sigmoidopexy was done in 7 patients. Total hospital mortality was 6% (5 deaths). Mortality in the 84 operated cases was 5% (4 deaths). CONCLUSIONS There was no mortality in patients undergoing elective resection and primary anastomosis after successful preoperative deflation and in patients with viable sigmoid volvulus who underwent an emergency Hartmann's procedure. There was low mortality in those patients with resection and primary anastomosis on viable sigmoid (3%, 1:39). The highest mortality (1:5) occurred in cases of resection and primary anastomosis of gangrenous sigmoid colon.

[1]  A. Keller,et al.  Emergency resection and primary anastomosis for sigmoid volvulus in an African population , 1990, International Journal of Colorectal Disease.

[2]  D. Kovač,et al.  Experimental and clinical study in the treatment of sigmoid volvulus. , 2001, Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti.

[3]  S. Thomson,et al.  The management of sigmoid volvulus. , 2000, Journal of the Royal College of Surgeons of Edinburgh.

[4]  Katherine S. Virgo,et al.  Sigmoid volvulus in Department of Veterans Affairs Medical Centers , 2000, Diseases of the colon and rectum.

[5]  A. K. Khanna,et al.  Sigmoid volvulus , 1999, Diseases of the colon and rectum.

[6]  T. Madiba,et al.  Histological evidence of hypertrophy and ischaemia in sigmoid volvulus among Africans. , 1999, East African Medical Journal.

[7]  R. Natarajan,et al.  Colostomy Closure: Impact of Preoperative Risk Factors on Morbidity , 1999, The American surgeon.

[8]  D. Mittal,et al.  Sigmoidopexy (tube sigmoidostomy) as definitive surgical procedure for sigmoid volvulus. , 1998, Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology.

[9]  C. Trillo,et al.  Primary anastomosis in the treatment of acute disease of the unprepared left colon. , 1998, The American surgeon.

[10]  B. Bhatnagar,et al.  Nonresective alternative for the cure of nongangrenous sigmoid volvulus , 1998, Diseases of the colon and rectum.

[11]  Ali Mk.  Treatment of sigmoid volvulus: experience in Gondar, north-west Ethiopia. , 1998 .

[12]  O. Lernau,et al.  Elective extraperitonealization for sigmoid volvulus: an effective and safe alternative. , 1997, Journal of the American College of Surgeons.

[13]  Y. Akgun.  Mesosigmoplasty as a definitive operation in treatment of acute sigmoid volvulus , 1996, Diseases of the colon and rectum.

[14]  K. Sliwa,et al.  Volvulus of the sigmoid colon at Baragwanath Hospital. , 1996, South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie.

[15]  A. Khanna,et al.  Extraperitonealization for sigmoid volvulus: a reappraisal. , 1995, The Australian and New Zealand journal of surgery.

[16]  T. Madiba,et al.  Sigmoid volvulus among Africans in Durban. , 1995, Tropical and geographical medicine.

[17]  G. Venuto,et al.  Sigmoid volvulus in West Africa: A prospective study on surgical treatments , 1993, Diseases of the colon and rectum.

[18]  T. Fabian,et al.  Sigmoid volvulus. A four-decade experience. , 1989, The American surgeon.