Acute sigmoid volvulus in a West African population

Background: Acute sigmoid volvulus is one of the commonest causes of benign large-bowel obstruction. Its incidence varies considerably from one geographic area to another. This study reviews its management in a relatively highprevalence area. Materials and Methods: All adult patients with acute sigmoid volvulus seen at the Royal Victoria Teaching Hospital (RVTH), Banjul, between September 2000 and January 2005 were retrospectively studied. Demographic data, clinical features, resuscitative measures, results of investigations, findings at surgery and postoperative course, and complications were retrieved from the patients' clinical records and analyzed. Results: A total of 48 patients, 45 (93.8%) males and 3 (6.3%) females, with a male: female ratio of 14.3: 1, age range of 19 to 78 years and mean age of 45.8 +/- 17.6 years underwent treatment for acute sigmoid volvulus. Twentyone (43.8%) of the patients were aged 40 to 49 years. Two (4.2%) had rectal tube detortion followed by elective sigmoidectomy and primary anastomosis on the same admission, while 24 (50%) had emergency laparotomy, at which bowel decompression, one-stage resection and primary anastomosis without on-table lavage were done. The rest of the patients, 22 (45.8%), had gangrenous sigmoid colons at laparotomy and consequently underwent resection and Hartmann's procedure. Fourteen (29.1%) patients developed wound infection; and 5 (10.4%) had prolonged ileus, which was managed conservatively. There was no anastomotic leak. The mean hospital stay was 11.1 days. There were 5 deaths, giving a mortality rate of 10.4%. Conclusion: Acute sigmoid volvulus in The Gambia is almost exclusively a male disease. Sigmoid colectomy and primary anastomosis can be carried out safely in those with viable colon without on-table colonic lavage.