Sigmoid volvulus: a review of cases at the Queen Elizabeth Hospital, Barbados 1986 - 1996 - abstract

ABSTRACT

Little has been published in the Caribbean about volvulus of the sigmoid colon. During the years 1986 to 1996 records of 22 patients (41 admissions) with acute sigmoid volvulus were found and reviewed. 41 episodes of sigmoid volvulus in these patients were diagnosed and are the subject of this study. Nearly 90 percent of patients presented with the typical triad of abdominal pain, marked abdominal distension and constipation. An X-ray of the abdomen confirmed the diagnosis in 90 percent of patients diagnosed clinically. The male/female ratio of patients was 74. All patients were over the age of 50 years. 60 percent of the patients lived in nursing homes or long term care institutions. In spite of the uncommon occurrence of the disease a correct diagnosis was made in all the patients preoperatively. Nonoperative decompression was performed successfully in 44 percent of patients. Surgical treatment consisted of laparotomy and simple untwisting in six patients (22 percent), resection and colostomy in nine patients (33 percent) and primary resection and anastomosis in nine patients (33 percent). The majority of patients (83 percent) required emergency laparotomy with a mortality of 15 percent. The reccurrence rate was high for patients who had non-operative decompression alone (40 percent) or simple untwisting at operation (83 percent). An elective primary resection in those patients who had been decompressed initially was done in four patients without any complications. 50 percent of patients had a previous episode of sigmoid volvulus. 5 patients had more than one occurrence. We feel that initial management of sigmoid volvulus by attempts at endoscopic decompression should be followed by elective resection during the same hospitalisation. (AU)