Factors Influencing Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study

Introduction: Sigmoid volvulus (SV) is one of the commonest causes of intestinal obstruction in Uganda. The purpose of this study was to determine the factors influencing the outcome of SV in Northern Uganda.
Methodology: A prospective observational study was conducted on 103 sigmoid volvulus patients admitted between January 2012 to December 2012 and surgically managed in 19 hospitals in Northern Uganda and followed up postoperatively for 30 days. Surgical management was by resection and primary anastomosis or Hartmann’s procedure or double barrel colostomy. Patients 13 years and above with sigmoid volvulus and who had consented/Assented were included in the study and followed up to the 30th postoperative day. Ethical approval for the study was obtained from the Institutional Review Committee of Gulu University and Uganda National Council for Science and Technology. Data analysis was carried out using STATA/IC version 12.1. The outcome events were uneventful recovery, morbidity and mortality.
Results: Eighteen(17.48%) patients developed complications including wound sepsis 10 (9.7%); wound dehiscence 8(7.7%) and anastomotic leak 8(7.7%). There were 8 deaths, giving a mortality rate of 7.7%. The factors associated with a high risk of adverse outcome were hypernatraemia (RR=14.9; 95% CI: 1.46-152.9) and ileo-sigmoid knotting (RR = 4.94; 95% CI: 1.30-18.78). Resection and primary anastomosis had a better outcome compared to Hartmann’s procedure (RR=0.15; 95% CI: 0.02-0.099).
Conclusion: The risk factors associated with morbidity and mortality were preoperative hypernatraemia and ileo-sigmoid knotting. Colostomy was associated with a higher risk of morbidity and mortality than resection and primary anastomosis.