Retrospective Study on Pattern and Outcome of Management of Sigmoid Volvulus

Background: Sigmoid Volvulus is the commonest cause of large bowel obstruction. Its Prevalence varies geographically. This research was conducted to assess the causes, clinical manifestation, surgical technique and result in our institution, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, of intestinal obstruction patients. Methods: A facility based retrospective cross-sectional review of surgical records was done to identify patients who had acute sigmoid volvulus. Data was collected from surgery department, SKMCH, Muzaffarpur. The collected data was checked for its completeness, and then entered, edited, cleaned and analyzed using statistical Package for the Social Sciences (SPSS) version 22.0. For all statistical significance tests the cut-off value set was P < 0.05. Result: A total of 131 patients were managed for acute sigmoid volvulus. 108 (82.4%) were men with a male to female ratio of 4.7:1. The hospital prevalence of acute sigmoid volvulus was 27.9%. Majority (42%) of the patients were in the 6th decades of life. Abdominal pain, abdominal distention & inability to pass feces & flatus were the predominant presenting complaint while abdominal distention was the dominant physical finding in all of the patients. Ninety-seven patients (74%) had viable bowel obstruction of which 29 patients had successful rectal tube deflation. The remaining 68 patients were managed operatively by either primary resection & anastomosis (62 patients) or derotation alone (6 patients). Thirty-four patients had gangrenous bowel obstruction and were managed by either primary resection and anastomosis (16 patients) or Hartman’s colostomy (18 patients). Six patients died of which 5 had primary resection and anastomosis (2 for viable and 3 for gangrenous bowel obstruction).The predominant postoperative complication was wound infection in 11(10.7%) patients. Factors associated with unfavorable outcome were female sex, primary resection & end to end anastomosis and presentation of illness more than 24 h. Conclusion: The most common management primary resection and anastomosis. The overall mortality rate was 4.5% and the mortality rate related to primary resection and end to end anastomosis 6.4%. Mortality rate higher in those patients who had resection and anastomosis for gangrenous bowel compared to those who had viable bowel compared to those who had viable bowel (19 % vs 3%). Generally factors associated with poor outcome were duration of illness, primary resection and anastomosis and female.