RESUMEN
AIM: In sub-Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini-laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of "Enhanced Recovery After Surgery (ERAS)", in a low-resource setting. MATERIALS AND METHODS: Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini-laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively. RESULTS: From 1 March 2012 to 1 September 2017, 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini-laparotomy. There were 29 men and 2 women, median age 57 (range 17-92) years. Patients were operated after a median period of 4 (range 1.5-18) hours. The median duration of the operative procedure was 50 (range 30-105) minutes. Two patients died (6.3%). One patient died during an uncomplicated operation. The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann's procedure, he died on the 17th post-operative day as a result of a HIV-related double-sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patient haematuria after bladder catheter insertion. CONCLUSION: Acute sigmoid resection and primary anastomosis via a mini-laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.
Asunto(s)
Vólvulo Intestinal/cirugía , Enfermedades del Sigmoide/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Protocolos Clínicos , Colon Sigmoide/cirugía , Femenino , Hospitales Rurales/estadística & datos numéricos , Humanos , Vólvulo Intestinal/epidemiología , Laparotomía , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Atención Perioperativa , Estudios Retrospectivos , Enfermedades del Sigmoide/epidemiología , Factores de Tiempo , Adulto Joven , Zambia/epidemiologíaRESUMEN
A 44-year old woman came with an ulcerating wound, covering both mammas and axillas. Because of an extreme fear for doctors, the woman hid this for more than a year. The diagnoses was an inoperable T4N3M1 mamma carcinoma. Patient was treated with palliative hormonal therapy with good effects.
