Sigmoid Volvulus and Ileosigmoid Knotting at St. Mary’s Hospital Lacor in Gulu, Uganda

Background : 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 : One hundred eighty two patients aged 10 years and above met the inclusion criteria. They had fasted 6 hours prior to the operation and undergone both general anaesthesia and surgery. Patients who had medical and surgical conditions that led to nausea and vomiting were excluded. 53% of the patients were males and 43% were females. The prevalence of PONV was 40.7% within 24 hours after surgery. Factors that were statistically significantly (p value < 0.05) associated with PONV following univariate analysis included : age group 20 to 30 years, female gender, history of PONV, intra-operative use of Pethidine, type of operation (orthopaedic surgery) and postoperative use of Pethidine. Independent predictors of PONV include; age group of 20 to 30 years, history of PONV, and the type of operation.
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.