Yousaf Jan, Waqas, Shaukat Hussain, Muhammad Shah.
Choice of Operative Technique for Emergency Cases of Sigmoid Volvulus & its Outcome.
Ophthalmol Update Jan ;12(3):201-4.

Background: Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people. Most common presenting symptom is abdominal pain and constipation. Objective: The objective of this study is to describe the emergency management of sigmoid volvulus with reference to the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus. Materials and Methods: All patients presenting with volvulus and needing emergency operative intervention during one and a half years duration from January 2010 to July 2011 were included in this study. Demographics, laboratory and treatment results, mortality and complications were recorded. Total 54 patients were included in the study of which 21 presented with gangrenous sigmoid colon on laparotomy and viable sigmoid colon was present in the remaining 33 cases. Results: A total of 54 patients were studied. Their age ranged from 20-70 years with a mean of 47.3±17.4 years. There was a preponderance of male (83.3%) with a male to female sex ratio of 5:1 (Table 1). Twenty one patients (38.9%) presented with peritonitis. About 71.1% of the patients were treated with primary resection and anastomosis, 17.3% with Hartmann and 7.6% had Mikulicz procedure (Table 2). About 7.7% had anastomotic leak and 11.5% had wound infections. The average hospital stay was 8 days. Overall mortality rate was 5.7% and of the patients who died, all had primary resection and anastomosis for gangrenous bowel (Table 3). Conclusion: Bowel viability is the most important determinant of the outcome in a patient with sigmoid volvulus. Hartmann?s procedure goes a long way in decreasing mortality due to sigmoid volvulus (especially in gangrenous bowel) in the emergency setting.

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