Characteristics of Intestinal Volvulus and Risk of Mortality in Malawi

Abstract

Background Intestinal volvulus is a common cause of mechanical intestinal obstruction (MIO) in Africa. Sigmoid volvulus has been well characterized in both high-income and low-income countries, but there is also a predilection for small bowel volvulus in sub-Saharan Africa. Methods An analysis was performed of the Kamuzu Central Hospital Acute Care Surgery Registry from 2013 to 2019 on patients presenting with intestinal volvulus. Bivariate analysis was performed for covariates based on the intestinal volvulus type. Multivariate Poisson regression models estimated the relative risk of volvulus and mortality. Results A total of 4352 patients were captured in the registry. Overall, 1037 patients (23.8%) were diagnosed with MIO. Intestinal volvulus accounted for 499 (48.1%) of patients with MIO. Sigmoid volvulus, midgut volvulus, ileosigmoid knotting, and cecal volvulus accounted for 57.7% (n = 288), 19.8% (n = 99), 20.8% (n = 104), and 1.6% (n = 8), respectively. Mean age was 46.8 years (SD 17.2) with a male preponderance (n = 429, 86.0%) and 14.8% (n = 74) mortality. Overall, the most common operations performed were large bowel (n = 326, 74.4%) and small bowel (n = 76, 16.7%) resections with 18.0% (n = 90) ostomy formation. Upon regression modeling, the relative risk for volvulus was 2.7 times higher in men than women after controlling for season and age. There was no statistically significant difference in the relative risk of mortality based on the type of volvulus. Conclusion Volvulus is a significant cause of primary bowel obstruction in sub-Saharan Africa. Type of intestinal volvulus is not associated increased risk of mortality. Reasons for increases in the incidence of small bowel volvulus are still largely undetermined.

Sigmoid Volvulus in the Developing Countries: The Lack of Resources Might be a Blessing in Disguise

“…More than half of patients in this study (78.12%) reached the hospital after 24 h following the onset of symptoms which is similar to other studies (8). Diagnostic delay is divided into "prehospital delay" that is common in low-resource communities and "hospital delay" mainly related to diagnostic imaging di culties (2,17). Patients with sigmoid volvulus usually present with colicky abdominal pain and obstipation.…”

“…Sigmoid volvulus is an abnormal twist of the sigmoid colon around its own mesenteric axis of more than 180 degrees (8). The geographic distribution of this disease describes a "volvulus belt" that includes Africa, Asia, Middle East, Eastern Europe and Latin America (16)(17)(18). Over there, sigmoid volvulus represents 20-50% of large bowel obstruction (2) and reaches nearly 80% in Ethiopia and Andes (8,19).…”

Comments on ‘Acute Colonic Volvulus in a Mexican Population: A Case Series’

“…Firstly, while ISK/SV ratio is 1:12.9 in our series, it is from 1:1.6 to 1:2.9 in the reports from sub-Saharan Africa [ 5 , 6 ]. As seen, ISK constitutes a certain amount of colonic volvulus cases, the incidence of which is reported to be relatively higher in ‘volvulus belt’ African countries.…”

Is single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage a safe procedure?

“…Life threatening complications eg sigmoid gangrene, perforation, peritonitis, sepsis and death may occur if not diagnosed on time. [11][12][13][14][15] Surgical resection and primary anastomosis because of its good procedure outcome reports is in high demand over the past ten years. 16 Non operative procedures like enema, sigmoidoscopy or rectal tube is preferred in selected patients.…”