Management of acute sigmoid volvulus in a tertiary hospital north central nigeria: The place of advanced radiodiagnostics

Abstract

Background: Volvulus involves the twisting of an air-liquid stool-filled thin-walled segment of an intestine around its necessarily narrow mesenterial base, thereby strangulating the blood vessels, which often causes necrosis of this redundant intestinal segment. Intestinal volvulus had always been supposed to be a disease of the blacks from West African and the Bushmen natives of South Africa. The West African subset became the index region. Surgery was the best treatment for the full-blown disease. Conservative methods of management have only just been developed and studied in the Scandinavian countries. Scandinavian early rectosigmoidoscopic reductions of the twisted colonic segment have offered some valuable alternative helps.

Methods: We studied the documents of all the 44 patients who had a presumptive diagnosis of acute or subacute colonic volvulus and were admitted to surgical management. Biostatistics, exact history taking of the patients, carefully structured physical examination, and a good digital scout X-ray investigation of the abdomen helped to make a rapid diagnosis. Laparotomies confirmed such a diagnosis. We did not regularly attempt to do recto-sigmoidoscopic untwisting of the volvuli. All had Hartmann’s procedure surgeries with terminal colostomies.

Results: Of the 41 patients admitted to surgical management, 31 were males and 10 were females with a ratio of 3:1. The timing of surgery influenced mortalities and morbidities greatly.

Conclusion: The diagnosis of acute volvulus was simple. We needed to record the medical history, took the proper physical examination, correctly explained the examination results, and only studied the abdominal X-ray film without resorting to advanced computer tomography.

Keywords: Absolute wind stoppage, safety checklist, dolichol-sigmoid, endemicity, Hartmann’s procedure, primary anastomosis.