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Sigmoid Volvulus (Study of 20 cases)

Ketan Vagholkar,Shantanu Chandrashekhar.

Abstract
Background: Sigmoid Volvulus is the third most common cause of colonic obstruction and accounts for 2-4% of internal obstructions. A variety of abdominal and functional factors contribute to the development of sigmoid volvulus. The progression of pathology is extremely rapid. Hence, understanding these factors enables early diagnosis and prompt surgical interventions.
Aims: 20 cases of surgically treated sigmoid volvulus were studied retrospectively to identify and evaluate various factors causing morbidity and mortality in these patients.
Results: The condition was commonly seen in males, especially those who were institutionalized and were using laxatives for over 5 years. The mean age was 65.2 years. Co-morbidities were a common accompaniment. 13 patients had diabetes, 12 patients had hypertension, 2 patients had ischemic heart disease and 9 patients had the neurological disease (Parkinsonís disease). 6 patients had single co-morbidity, 13 patients had 2 co-morbidities and 1 patient had 3 co-morbidities. A plain X-ray of the abdomen was diagnostic in all cases. The mean time interval from the onset of symptoms to hospital admission was 8.1 hours, the time interval from hospital admission to confirmation of diagnosis was 2.1 hours. The mean time interval from diagnosis to surgical intervention was 3.2 hours. The surgical options exercised were resection anastomosis with a proximal diversion in 13 patients, Hartmannís procedure in 6 patients, and primary resection anastomosis in 1 patient. Post-operative complications included ileus in 16 patients, stomal dysfunction in 4 patients, and surgical infections in 10 patients. The mean duration of stay in hospital ranged from 7-13 days. Only 1 patient who had 2 co-morbidities developed complications and succumbed.
Conclusion: Prompt diagnosis, optimization of haemodynamic status including co-morbidities is essential before contemplating surgical intervention. Resection anastomosis with a proximal diverting stoma is best suited for patients who have not developed a colonic perforation whereas Hartmannís procedure is indicated in patients presented with perforative peritonitis.

Key words: Sigmoid volvulus diagnosis treatment.



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