Clinical profile and Factors associated with adverse outcome following Surgery for Sigmoid Volvulus: A multi centre study

Abstract

Introduction In Uganda, one of the leading causes of intestinal obstruction is sigmoid volvulus. Due to unavailability of endoscopic services in some settings, most of the patients usually undergo emergency surgery. The aim of this study was to determine the clinical profile and factors associated with early adverse outcome following surgery for sigmoid volvulus at Jinja, Hoima and Fortportal regional referral hospitals (FRRH, HRRH and FRRH respectively). Methods This was an observational prospective cohort done at 3 regional referral hospitals in Uganda. Patients undergoing surgery for sigmoid volvulus were enrolled consecutively and followed up till the time of discharge or death to document the mortality, occurrence of complications and length of hospital stay. Data analysis was done using SPSS version 26 with Poisson regression done to determine the factors. Results In this study that enrolled 81 participants, majority were males 63(77.8%) with a mean age of 55.1(SD=14.2) years. Hemodynamic instability was seen in 27(33.3%), non-viable gut in 27(33.3%) with colostomies placed in 61(75.3%) of the participants. Death occurred in 10(12.3%) of the patients, while 37(45.7%) had at least one complication with the commonest complication being surgical site infection 21(25.9%). The median length of hospital stay (LOS) was 8(IQR=7-11) days. At multivariate level of analysis, hyperkalemia (aRR=2.210, CI=1.512-3.630, P=0.024) and presence of a sigmoid perforation (aRR=1.913, CI=1.015-3.962, P<0.001) were independently associated with mortality, hypertension (aRR=2.726, CI=1.206-6.158, P=0.016) and presence of hemodynamic instability (aRR=2.500, CI=1.561-4.004, P<0.001) associated with occurrence of complications, while duration of symptoms greater than 3 days (aRR=1.217, CI=1.016-1.458, P=0.033) and hemodynamic instability (aRR=1.165, CI=1.017-1.335, P=0.028) were independently associated with prolonged hospital stay. Conclusion A big proportion of the participant’s presented with hemodynamic instability and non-viable gut resulting in placement of many colostomies. The mortality and morbidity were high as well as the length of hospital stay. More sensitization in relation to early presentation to hospital is still needed in order to reduce the number of patients that present with hemodynamic instability and non-viable or perforated sigmoid which in turn could improve the outcomes.