Konkena Janardhana Rao, Naveen Kumar Podili, Metta Rajagopal
BACKGROUND Sigmoid volvulus is a common cause of large bowel obstruction in developing countries where it affects relatively young people compared to developed countries and its mortality remains significant in patients with late diagnosis. The aim of this work is to assess the clinical presentation, management and outcome of sigmoid volvulus. MATERIALS AND METHODS A retrospective clinical study including all the patients treated for sigmoid volvulus in the Department of General Surgery, King George Hospital, Visakhapatnam, from January 2013 to January 2018. RESULTS A total of 128 patients (M:F = 3:1) representing 11.63% (128/1100) of all cases of colonic obstruction were studied. The median age at presentation was 52 years. The disease significantly affected the older males compared with females. The majority of the patients 108 (84.37%) presented acutely and had to undergo emergency surgical intervention, the rest were either subacute or chronic. The majority of patients, 93 (72.65%) were treated with Hartman’s procedure, of which all were emergency cases. Resection and primary anastomosis was offered to 35 (27.35%) cases, of which 15 (42.85%) were emergency with remaining being elective. No patient had sigmoidoscopic derotation and sigmoidopexy. The overall median length of hospital stay was 12 days. Overall morbidity rate was 39.84% (51), surgical site infection being the predominant cause. Overall mortality rate was 14.84% (19). The main predictors of mortality were advanced age (>60 years), concomitant medical illness, late presentation (≥24 hours), presence of shock on admission and presence of gangrenous bowel. CONCLUSION Sigmoid volvulus is not uncommon in our setting and commonly affects males than females. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. Findings from this study suggest that temporary colostomy should be considered if the bowel is gangrenous or perforated or patient conditions precluding primary anastomosis like shock. Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease.
