Emergency resection and primary anastomosis for sigmoid volvulus in an African population

We report 30 patients who underwent operation for sigmoid volvulus during a two year period at the St. Francis Hospital, Tanzania. Five patients were managed initially by non-operative reduction. They all underwent elective resection of the sigmoid during the same hospitalisation with one operative death. Twenty-five patients underwent emergency laparotomy, 12 of them having gangrenous bowel. Resection was carried out in 21 patients, 18 of whom had a primary anastomosis without protective colostomy. In spite of the high incidence of gangrenous bowel (57%), there was only one operative death (5%) in the 18 patients. Initial management of sigmoid volvulus should consist of non-operative attempts at reduction provided that the bowel is viable. Elective resection should be performed during the same hospitalisation. Where non-operative therapy fails or bowel gangrene is present, emergency laparotomy has to be carried out. In the authors' experience resection of the sigmoid and primary anastomosis can be performed safely in this situation.