Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa
Abstract
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