Sigmoid Volvulus and Ileosigmoid Knotting at St. Mary’s Hospital Lacor in Gulu, Uganda.
Loading...
Date
2009
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
East and Central African Journal of Surgery
Abstract
Sigmoid volvulus is a common cause of intestinal obstruction in developing
countries where it affects relatively young people. Little is known about this condition in
our country and there is yet no literature from an environment like ours (northern
Uganda) where civil war has devastated the economy with most of the populace displaced
into internally displaced peoples’ camp. The main objective of this study was to determine
the demographics, treatment and outcome of sigmoid Volvulus cases seen at Lacor
Hospital.
Methods: This was both a retrospective and prospective study of patients who presented
with sigmoid volvulus at St. Mary’s Hospital Lacor over a period of 61/2 years from 1st
January 2002 to 31st July 2008. Medical records of patients who underwent sigmoid
surgery was stratified for the following measures; demographic characteristics,
presentation to hospital (emergency or elective), operative finding and operative
procedure, complication, co-ominous factors and outcome. Similar data was gathered from
patients who were prospectively followed up. Data was analyzed using SPSS.
Results: A total of 44 patients were studied. Their age ranged from 16 to 80 years with a
mean of 52.2years (SD +/- 15.98) and a mode of 60years. There was a preponderance of
male (84%) with a male to female sex ratio of 5.3: 1. The disease significantly affected the
older males compared with females P=0.032. Approximately 77% of the patients presented
acutely and had to undergo emergency surgical intervention, the rest were subacute.
About 75% of the patients were treated with primary resection and anastomosis, of which
52.2% were emergency cases. Colostomy was offered to 20.5% and sigmoidoscopic
derotation to 4.5%. Overall mortality rate was 15.9% and of the patients who died, 18%
had primary resection and anastomosis, while 11% were offered colostomy, (P>0.05). Most
of those who died were either the older ones (median age 68years) and/or had co morbid
illness such as diabetes mellitus, hypertension, intra-abdominal abscess and cancer.
Conclusion: Sigmoid volvulus is relatively rare in our community. It commonly affect
males particularly the old. Most of the patients presented acutely, requiring immediate
resuscitation and surgical approach. In viable bowel, primary resection and anastomosis of
the twisted sigmoid is feasible as it may not adversely affect outcome. Nevertheless
colostomy should be considered if the bowel is gangrenous or perforated. Though the
disease carries a high mortality, most of the patient who die are either older and/or have
co-morbid conditions.
Description
Keywords
Sigmoid Volvulus, Ileosigmoid Knotting, St. Mary’s Hospital Lacor, Uganda
Citation
Okello, T. R., Ogwang, D. M., Kisa, P., & Komagum, P. (2009). Sigmoid volvulus and ileosigmoid knotting at St. Mary’s Hospital Lacor in Gulu, Uganda. East and Central African Journal of Surgery, 14(2), 58-64.