Volvulus of the sigmoid colon in the Gezira

Abstract

Out of 34 consecutive patients presenting with volvulus of the sigmoid colon the Gezira area of The Sudan, 30 were western Sudanese farmers (age range 25-52 years) who habitually ate a single daily meal of high residue food: their colons were long and hypertrophied. In contrast, the 4 northern Sudanese (age range 60-92 years) ate a Western European type of diet and had a thin colon. This factor may have been responsible for the finding that the 5 patients presenting with gangrene of the sigmoid colon included all 4 northern Sudanese patients. Shock was a reliable indicator of gangrene but rebound tenderness was valueless. Deflation of the sigmoid volvulus via the sigmoidoscope succeeded in curing 19 of 25 patients in whom there was no suspicion of gangrene (4 later recurrences). Laparotomy was performed in the other 15 patients with operative untwisting in the absence of gangrene in 10 (2 later recurrences), and resections in the presence of gangrene (3 died).

Adult large bowel obstruction: A review of clinical experience

“…Sigmoid volvulus occurred in those with long sigmoid mesenteries and narrow mesentery attachment, as observed in previous studies. [2,5,10] Although aetiologically important, especially in rare childhood cases, [11] dietary factors are also a contributing factor. [10,12] In developing countries, a high-fibre cereal diet commonly eaten is responsible for the high incidence of sigmoid volvulus.…”

“…[2,5,10] Although aetiologically important, especially in rare childhood cases, [11] dietary factors are also a contributing factor. [10,12] In developing countries, a high-fibre cereal diet commonly eaten is responsible for the high incidence of sigmoid volvulus. [10,12,13] There was no appreciable difference in site distribution of obstruction in patients with colon cancer in our series over that reported previously.…”

“…[10,12] In developing countries, a high-fibre cereal diet commonly eaten is responsible for the high incidence of sigmoid volvulus. [10,12,13] There was no appreciable difference in site distribution of obstruction in patients with colon cancer in our series over that reported previously. [14,15] There were also no identifiable premalignant lesions in resected specimens, thus suggesting premalignant lesions, eg, adenoma, familial adenomatosis, polyposiscoli, etc, may not be usual associations in our environment as documented in western literature.…”

Acute sigmoid volvulus in a West African population

“…[6,7] The nonresectional procedures sigmoidopexy and mesosigmoidoplasty have no need for bowel preparation and have lower morbidity and mortality rates but have high incidence of recurrence. [8] Where the decompression fails and there are signs of colonic gangrene, sigmoid resection and Hartmann's procedure or colostomy with mucous fistula is done to avoid the high mortality associated with primary anastomosis in this situation. [9] Recently laparoscopic resection has been used in high-risk or elderly patients who may not tolerate conventional surgery.…”

Intraoperative colonic irrigation in the management of left sided large bowel emergecies in Jos University Teaching Hospital, Nigeria

“…Furthermore, mortality following emergency surgery for acute sigmoid volvulus is low in the developing world despite debilitation resulting from delayed presentation, for example, 5% in Tanzania, 16% in Nigeria, 20% in Sudan (35)(36)(37). This may be due to the fact that in the developing world, as in this series, the patients are usually young and healthy (38).…”