Sigmond Colon Volvulus Management: An analysis of factors contributing to morbididty amd mortality in single and double stage operations
Syakantu, Gardner Simwemba
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A prospective study has been carried out at the University Teaching Hospital (UTH), Lusaka, over a period of one and a half years (July 1995 to December 1996) to study the factors contributing to morbidity and mortality in the treatment of sigmoid colon volvulus and also compare the outcome of single stage versus double stage operations. Fifty four consecutive patients presenting to the UTH with sigmoid volvulus were entered into the study. Fifty two were treated as emergency cases with acute intestinal obstruction due to sigmoid volvulus and three were elective cases. The details of each patient was collected and entered an a proforma designed for the study. The information collected included the name, age and sex of the patient, file number, date of admission, admitting surgical firm, name of the firm consultant, and the mode of surgery, whether emergency or elective. The pre-operative details including symptoms, duration of illness, history of previous operation, vital signs (Blood pressure, pulse, temperature) level of hydration, urine output and whether or not there was any concomitant disease. Radiographs of the abdomen in the supine and erect position, measure of urea, sodium, potassium, chloride and full blood count were done when the facility was available. The operative data included, the surgeon's and the anaesthetist's name and seniority, bowel appearance, type of operation done and whether or not blood was given intraoperatively. Post operative course of the patient was recorded until the time of discharge from the ward. Follow-up was up to the time of discharge from the Surgical out-patient clinic. Twenty seven patients underwent double staged operations. These were subdivided into resection, anastomosis and transverse colostomy (n=10); resection and double barrel colostomy (n=13); and Hartmann's operation (n=4). There were five mortalities in these 27 patients, with 11 patients developing complications, mostly colostomy related such as prolapse (n=6), bleeding colostomy (n=l), Burst abdomen following colostomy break down (n=l), wound infection (n=4) and anastomotic leak after colostomy closure (n=3). Twenty five patients underwent primary resection with immediate anastomosis. One died post-operatively after an anastomotic leak and five developed complication of wound infection (n=2), intestinal obstruction due to hernia (n=l), prolonged ileus (n= 1) and chest infection (n= 1). One patient had a deflation of the volvulus by tube and absconded on the third day while another had an operative reduction and was subsequently lost to follow up. The morbidity and mortality rate seen in single stage operation was 20 percent and 4 percent respectively, while in double staged operations it was 40.7 percent and 18.5 percent respectively. Presence of bowel gangrene was associated with a 45.4 percent mortality.
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