Volvulus of the sigmoid colon in the Gezira

Out of 34 consecutive patients presenting with volvulus of the sigmoid colon the Gezira area of The Sudan, 30 were western Sudanese farmers (age range 25-52 years) who habitually ate a single daily meal of high residue food: their colons were long and hypertrophied. In contrast, the 4 northern Sudanese (age range 60-92 years) ate a Western European type of diet and had a thin colon. This factor may have been responsible for the finding that the 5 patients presenting with gangrene of the sigmoid colon included all 4 northern Sudanese patients. Shock was a reliable indicator of gangrene but rebound tenderness was valueless. Deflation of the sigmoid volvulus via the sigmoidoscope succeeded in curing 19 of 25 patients in whom there was no suspicion of gangrene (4 later recurrences). Laparotomy was performed in the other 15 patients with operative untwisting in the absence of gangrene in 10 (2 later recurrences), and resections in the presence of gangrene (3 died).