Management of gangrenous sigmoid volvulus at Tenwek Hospital in western Kenya
Background: Bowel gangrene has a negative impact on outcomes of patients with sigmoid volvulus (SV). This study aimed at evaluating the management and outcomes of patients with gangrenous sigmoid volvulus and assessing the utility of primary anastomosis as a management option.
Methods: An 11-year (January 2006-December 2016) descriptive retrospective chart review of patients managed for SV at Tenwek Hospital in Bomet, Kenya.
Results: A total of 46 cases were identified, representing 25.4% of all cases of SV noted during the study period. The group had a mean age of 47.3 years (range 15-81), mean symptom duration of 2.2 days (range 2 hours-7 days) and a male predominance of 87%. Primary anastomosis (PA) without a proximal diverting colostomy was performed in 24 cases and a Hartmann's procedure (HP) was performed in 22 cases. Patients who had a HP were noted to have had a longer duration of symptoms and a higher incidence of peritonitis than those who had a PA (2.7 vs 1.8 days, P = 0.02; and 72% vs 42%, P = 0.04). All patients with concurrent colonic perforation (n = 3) had a HP. Seven patients died, giving an overall mortality of 15.2%. There was an anastomotic leak rate of 4.2% and a mortality rate of 8.3% among the subset of patients who had a PA.
Conclusions: Primary anastomosis can be safely performed with good outcomes in patients with gangrenous SV, and the presence of bowel gangrene does not mandate a diverting colostomy.
Keywords: sigmoid volvulus; bowel gangrene; primary anastomosis; colostomy; bowel obstruction