Emergency Management of Sigmoid Colon Volvulus in a Volvulus Belt Population and a Review of Literature
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Algorithm for management of acute sigmoid volvulus is still controversial. This study was undertaken in a volvulus belt population emphasizing on emergency resection and primary anastomosis without on-table colonic irrigation or diversion. Four hundred forty-five acute sigmoid volvulus patients were reviewed retrospectively. Records of 366 operated patients were studied thoroughly. After operative detorsion and simple decompression, resection and primary anastomosis without a diverting stoma with postoperative anal dilatation were done in those who obeyed certain criteria; the rests were subjected for alternative operations. Ileal resection anastomosis was added in compound volvulus cases. Literature was reviewed. Epidemiology: constitutes 40.4% of small and large intestinal and 87.8% of large intestinal obstruction cases; maximum of 40–60 years with slight male preponderance. Operated: 148 gangrenous, 10 compound, 3 perforated, and 205 uncomplicated patients—mesocoloplasty in 2; resection with primary anastomosis in 270 including 60 gangrenous, 6 compound, and 1 perforated; 92 Hartmann’s procedure and 2 Paul Mickulicz in other gangrenous cases. Mortality: with primary anastomosis 7.4% with no significant difference between gangrenous and non-gangrenous groups; with no restoration of continuity 19.2% and overall 7.5% without gangrene, 14.3% with gangrene and 10.4% in an average; in reducing trend with ICU facility. There was no death with compound volvulus. Morbidity with primary anastomosis: 5.9% anastomotic leak, 9.6% wound infection, and 1% wound dehiscence. Emergency resection and primary anastomosis after decompression without on-table lavage are safe procedures in developing nations in patients who are stable at presentation or after resuscitation having favorable intraoperative criteria.
KeywordsVolvulus Sigmoid colon Compound volvulus Resection primary anastomosis On-table lavage Surgical stomas
I am extremely grateful to Dr. Sachin Patil, then PG resident, for helping in the collection of records during the first 2 years of the study period.
Compliance with Ethical Standards
Conflict of Interest
The author declares that there is no conflict of interest.
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