2 research outputs found
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: A total of 44 patients were studied. Their age ranged from 16 to 80 years with a mean of 52.2years (SD +/- 15.98) and a mode of 60years. There was a preponderance of male (84%) with a male to female sex ratio of 5.3: 1. The disease significantly affected the older males compared with females P=0.032. Approximately 77% of the patients presented acutely and had to undergo emergency surgical intervention, the rest were subacute. About 75% of the patients were treated with primary resection and anastomosis, of which 52.2% were emergency cases. Colostomy was offered to 20.5% and sigmoidoscopic derotation to 4.5%. Overall mortality rate was 15.9% and of the patients who died, 18% had primary resection and anastomosis, while 11% were offered colostomy, (P>0.05). Most of those who died were either the older ones (median age 68years) and/or had co morbid illness such as diabetes mellitus, hypertension, intra-abdominal abscess and cancer.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
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