Acute sigmoid volvulus in a West African population

Area of Science:

• Gastroenterology
• Surgical Management
• Public Health

Background:

• Acute sigmoid volvulus is a frequent cause of benign large-bowel obstruction with variable geographic incidence.
• This study focuses on the management of sigmoid volvulus in a region with a high prevalence of the condition.

Purpose of the Study:

• To review the management of acute sigmoid volvulus in The Gambia, a high-prevalence area.
• To analyze patient demographics, clinical presentation, treatment outcomes, and complications.

Main Methods:

• Retrospective study of adult patients diagnosed with acute sigmoid volvulus at the Royal Victoria Teaching Hospital (RVTH) from September 2000 to January 2005.
• Data collection included demographic information, clinical features, investigations, surgical findings, and postoperative course.
• Analysis of retrieved patient records to evaluate management strategies and outcomes.

Main Results:

• The study included 48 patients, predominantly male (93.8%), with a male to female ratio of 14.3:1. The mean age was 45.8 years.
• Surgical interventions included decompression with sigmoid colectomy and primary anastomosis (50%), resection and Hartmann's procedure for gangrenous colons (45.8%), and rectal tube detortion followed by sigmoidectomy (4.2%).
• Complications included wound infection (29.1%) and prolonged ileus (10.4%), with no anastomotic leaks. The mortality rate was 10.4%.

Conclusions:

• Acute sigmoid volvulus in The Gambia is overwhelmingly a male-predominant condition.
• Sigmoid colectomy with primary anastomosis is a safe and effective treatment for patients with viable colons, even without intraoperative colonic lavage.