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A Clinical Study of Sigmoid Volvulus Modalities of Management

Damuluri Ramu, Resident Surgical Oncology, St. Johns Medical College, Bengaluru, Karnataka 560034, India. , D. Ramu1 , V. Ramprasdad2 , S. Arun3 , N.V.N. Reddy4

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New Indian Journal of Surgery 9(4):p 490-494, July - August 2018. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9418.17

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Abstract

Introduction: Volvulus is the abnormal twisting or rotation of a portion of the bowel about its mesenteric axis. This may cause occlusion of the lumen at each end of the segment with resultant obstruction and vascular compromise.

Aim of the study: The aim is to study various modes of presentations of Sigmoid Volvulus and various modalities of management in Gandhi Hospital.

Materials and Methods: Total of 20 cases of sigmoid volvulus, which presented to
emergency department, Gandhi General Hospital were studied, in a period of two and half years from August 2012 to November 2014. Abdomen was taken and in few patients, in whom, sigmoid volvulus could be diagnosed pre­operatively, conservative measures were attempted, by passing flatus tube and /or S/W enema, after excluding strangulation or gangrene clinically as emergency sigmoidoscopy is not available, conservative measures were not successful. In all the cases, intra abdominal findings during surgery were noted. Subsequently to the procedure, they were placed in postoperative ward. All post operative complications were noted and dealt appropriately.

Results and Conclusion: Sigmoid volvulus is common in old age group i.e., 5th & 6th decades. Almost equal incidence in both sexes with slight preponderance in males with male to female ratio 1.2:1. In 60% of the patients the predisposing cause is long mesosigmoid with long dilated and redundant sigmoid colon. Gangrene is common (25% of cases) and is not related to duration of symptoms. Gangrene is  common in elderly compared to young patients. Conservative measures failed to relieve obstruction even temporarily in non­gangrenous sigmoid colon. (Emergency sigmoidoscopy is not available.) Fixation of sigmoid colon in the form of sigmoidopexy is associated with high recurrence rate (50%).  Unless general condition precludes, fixation of sigmoid colon should not be done as it is associated with high recurrence rate and it should be followed by elective sigmoid resection. In non­gangrenous sigmoid volvulus, resection and EEA is the best option. In selected group of patients where condition of the colon permits primary anastamosis can be done.

Keywords: Sigmoid Volvulus; Surgery.

 

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9418.17

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