Sigmoid volvulus among Africans in Durban

The pattern of presentation and management of 90 patients treated for sigmoid volvulus over a 7-year period was studied. There was a 9:1 male preponderance and 64% were under 50 years of age. Intestinal obstruction was the presenting feature in 84%, while the rest presented with acute abdomen or pain. Unlike other African series, this constituted only 8% of intestinal obstruction. Sixty-one per cent were managed by sigmoidoscopic decompression and semi-elective sigmoidectomy, and 30% had an emergency operation. A primary anastomosis was undertaken in 71% while others, mainly emergency cases, had a temporary colostomy. There was a 20% morbidity and 12% mortality, 80% of which was in the emergency operation group. It is concluded that the pattern of sigmoid volvulus among Durban Africans differs from that reported in other African countries where young males predominate, and from that in Western societies with elderly female preponderance. When volvulus necessitates emergency surgery, it carries a substantial mortality even in relatively young patients and therefore we advocate resection in all patients during the same hospital admission even in those whose torsion is easily reduced at sigmoidoscopy lest a recurrence fails to reduce.