We thank Dr. Atamanalp for his interest in our publication and for sharing his experience and intestinal volvulus series from Turkey. We present a six-year sub-Saharan African volvulus experience. Our observed incidence is high, and our numbers were only limited by the duration of data collection

Charles, A.

Gallaher, J.

Mabedi, C.

Maine, R.

Purcell, L.N.

Reiss, R.

Carolina Digital Repository

Authors’ Reply: Characteristics of Intestinal Volvulus and Riskof Mortality in MalawiLaura N. Purcell1 • Rachel Reiss1 • Charles Mabedi2 • Jared Gallaher1 • Rebecca Maine1 •Anthony Charles1,2Published online: 24 April 2020We thank Dr. Atamanalp for his interest in our publicationand for sharing his experience and intestinal volvulus seriesfrom Turkey. We present a six-year sub-Saharan Africanvolvulus experience [1]. Our observed incidence is high,and our numbers were only limited by the duration of datacollection.As stated, the ileosigmoid knotting (ISK)/sigmoidvolvulus (SV) ratio that we show is consistent with findingsin other regions in sub-Saharan Africa, confirming the highincidence of ISK. Unfortunately, it is merely speculative asto the anatomical basis for both sigmoid volvulus and ISK.We would refer you to the case–control study from ourgroup, evaluating the role of the anatomy of the sigmoidcolon in the development of sigmoid volvulus [2]. Weshow that contrary to the prevalent belief that the root ofthe mesosigmoid is narrow in patients with SV, themesosigmoid root width was similar in both cases andcontrol. Unfortunately, in our current series, we did notevaluate the anatomical characteristics of patients withISK.Lastly, we disagree with Dr. Atamanalp regarding ISKbeing known as a graver disease, and the difference inmortality observed can be attributable to time to presen-tation. To control for mean time to presentation betweenISK and SV, as ISK patient presented earlier than SVpatients, we deliberately risk-adjusted for time to presen-tation in our analysis, and there were no significant dif-ferences in risk-adjusted mortality between SV and ISK.There is still much work needed in elucidating reasonsfor the high incidence of volvulus in the sigmoid belt. Weare committed to adding to the body of knowledge.Reference1. Purcell LN, Reiss R, Mabedi C, Gallaher J, Maine R, Charles A(2020) Characteristics of intestinal volvulus and risk of mortalityin Malawi. World J Surg. https://doi.org/10.1007/s00268-020-05440-22. Akinkuotu A, Samuel JC, Msiska N, Mvula C, Charles AG (2011)The role of the anatomy of the sigmoid colon in developingsigmoid volvulus: a case–control study. Clin Anat 24(5):634–637Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations. Anthony Charlesanthchar@med.unc.edu1 Department of Surgery, University of North Carolina Schoolof Medicine, 4008 Burnett Womack Building, CB 7228,Chapel Hill, NC, USA2 Department of Surgery, Kamuzu Central Hospital, Lilongwe,Malawi

Authors’ Reply: Characteristics of Intestinal Volvulus and Risk of Mortality in Malawi

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Authors’ Reply: Characteristics of Intestinal Volvulus and Risk of Mortality in Malawi

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