Sigmoid volvulus: A clinical study with reference to management options

Abstract

Introduction: A volvulus is an abnormal twisting of the bowel on its mesenteric axis greater than 180 degrees, which produces an obstruction of the intestinal lumen and mesenteric vessels. Sigmoid volvulus is a surgical emergency and significant cause of large bowel obstruction with high mortality and morbidity. The disease is more prevalent in India, especially rural population. The patient may present with features of shock, generalized abdominal tenderness and peritonitis pointing towards the presence of an underlying gangrenous segment in sigmoid volvulus. This condition can be life threatening if proper resuscitation and appropriate emergent procedures are not done. This study analyses various management options in our institute which caters mainly to patients from the surrounding rural areas. Methods: The present work consists study of 40 cases, carried out to study the clinical course and manifestations of sigmoid volvulus and to study the various surgical methods of treatment and their outcome. This study was conducted in patients of sigmoid volvulus admitted in Department of General Surgery, Shyam Shah Medical College Rewa during the period of May 2016 to April 2018. Results: Sigmoidopexy was done in 8(20%) patients with 50% recurrence rate. Resection and Primary anastomosis done in 14(35%) patients, of which 2(14.28%) had anastomotic leak and 2(14.28%) patients expired. Resection and Primary anastomosis with diversion colostomy was done in 10(25%) patients, all of them recovered well in postoperative period and underwent colostomy closure after 12 weeks. Hartmann's Procedure was done in 8(20%) patients. Higher mortality rate (37.5%) was observed in this group in comparison to others. Common post-operative complication was found to be wound infection. Overall mortality rate was 12.5%. Conclusions: Although Primary resection anastomosis is considered gold standard treatment for sigmoid volvulus but in developing and resource poor nations Primary resection anastomosis with diversion colostomy is found to be a safer procedure in patients with chronic malnourishment and poor general condition. Hartmann's procedure is suitable only if the bowel is gangrenous and in elderly patients with short life expectancy. Morbidity and mortality can be reduced by early institution of appropriate resuscitative and therapeutic measures.