Abstract
Introduction: The management of sigmoid volvulus has remained a controversial issue to many surgeons. Rapid resection with colostomy fashioning has been done over time for gangrenous volvulus. However resection and primary anastomosis has also been described with less complications and a shorter hospital stay. Our aim was to study the safety and efficacy of emergency resection and primary anastomosis in gangrenous sigmoid volvulus without a proximal colostomy.
Materials and Methods: It was a prospective observational study at VIMSAR, Burla, Surgery dept. from October 2016 to July 2018. Includes all gangrenous volvulus cases who were subjected to emergency resection and primary anastomosis without proximal stoma. Cardiorespiratory unstable patients and obstruction due to malignant cases were excluded. Primary outcomes studied were faecal fistula, wound infection, intestinal obstruction and mortality. Follow up period was 2 months.
Results: Total 32 cases were having gangrenous volvulus. 8 cases we did Hartmann’s procedure due to distal mobilisation of bowel could not be done due to extension of gangrene .So we did Primary resection and anastomosis in 24 cases. 0ut of 24 cases (15 males and 9 females) there were two cases of anastomotic leak and fecal fistula(8.33%), seven cases of wound infection(29.16%), four cases of paralytic ileus(16.66%), one in shock(4.16%), one chest complication(4.16%) and mortality(12.5%).
Conclusion: Resection and primary anastomosis in gangrenous volvulus can be practised with few complications and a shorter hospital stay.
Keywords: Sigmoid volvulus, Gangrene, Primary anastomosis.
References
- Bolt DE. The management of volvulus of the sigmoid colon. Br J Surg 1956;44:172-5
- Williams M, Steffes CP; Sigmoid volvulus in a 46 year old man. Hospital Physician, 2006; 33-36.
- Jangjoo A, Soltani E, Fazelifar S, Saremi E, Afzal Aghaei M. Proper management of sigmoid colon volvulus: our experience with 75 cases. Int J Colorectal Dis2010; 25:407-9.
- Valentine Pastore, Angela Basile, Raffaella Cocomazzi, MarlenaPastore, Fabio Bartoli. Sigmoid volvulus in a neonate: Case report and review of literature; African J ournal of paediatric surgery Oct/Decm 2013 (10) issue 4; 390-392.
- Yassaie O, Fawcett MT, Rossaak J; Management og sigmoid volvulus: is early surgery justifiable? ANZ J Surg. 2013; 83(1-2):74-78.
- Spiegel A, Chugh T, Lebovics E; A review of colonic volvulus. PractGaastro., 2009: 42-46.
- Katsikogiannis N, Machairiotis N, Zarogoulidis P, Sarika E, Stylianaki A, Zisoglou M, et al. Management of sigmoid volvulus avoiding sigmoid resection. Case Rep Gastroenterol. 2012;6:293-9.
- Hadi A, Khan N, Shah SMA, Bangash A. Emergency management of sigmoid Volvulus: experience of Lady Reading Hospital . Peshawar. J Postgrad Med Inst 2006; 20:82-5.
- Dulger M, Canturk NZ, Utkan NZ, Gonullu NN. Management of sigmoid colon volvulus. Hepatogastroenterology 2000; 47: 1280-3.
- Bhatnagar BN, Sharma CL, Gautum A, Kakar A, Reddy DC. Gangrenous sigmoid volvulus: a clinical study of 76 patients .Int J Colorectal Dis.2004;19(2):134-42
- Cuschieri A, Steele RJC, Moossa AR. Essential surgical practice. 4th ed. London: Arnold Publication; 2002.
- Mellor MF, Drake DG. Colonic Volvulus in children: value of barium enema for diagnosis and treatment in the children. AJR. Am J Roentgenol.1994;162(5):1157-9
- Catalano O. Computed tomographic appearance of sigmoid volvulus.Abdom Imaging. 1996;21(4):314-7
- Kassi AB, Lebeau R, Yenon KS, Katche E, Diane B, Kouassi JC (2011) Morbidity and mortality of Hartmann's procedure for sigmoid volvulus at the University Hospital of Cocody, Abidjan. West Afr J Med 30 (3):169-172
- Richter S, Lindemann W, Kollmar O, Pistorius GA, Maurer CA, Schilling MK. One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey Stages III and IV). World J Surg 2006;30:1027-32.
- Aydin HN, Remzi FH, Tekkis PP, Fazio VW. Hartmann’s reversal is associated with high postoperative adverse events. Dis Colon Rectum 2005;48:2117-26.
- Meijer WS, Vermeulen J, Gosselink MP. Primary resection and side-to-end anastomosis next to and end-colostomy in the management of acute malignant obstruction of the left bowel: an alternative in selected patients. Tech Coloproctol 2009;13:123-6.
- Forster M E, Leaper D J, Williamson R C. Changing patterns in colostomy closure : the Bristol experience 1975 - 1982. Br J Surg 1985; 72 : 142 - 5.
- Baker DM, Wardrop PJ, Burrell H, Hardcastle JD. The management of acute sigmoid volvulus in Nottingham. J R CollSurg Edinb1994; 39:304-6.
- Khan M, Ullah S, Jan MAU, Naseer A, Ahmed S, Rehman A. Primary anastomosis in the management of acute sigmoid volvulus without colonic lavage. J Postgrad Med Inst 2007; 21:305-8.
- Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Basoglu M, Polat KY, Onbas O. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection. Experience with 827 cases. Dis Colon Rectum.2007;50(4):489-97 .
- Akcan A, Akyildiz H, Artis T, Yilmaz N, Sozuer E (2007) Feasibility of single-stage resection and primary anastomosis in patients with acute non complicated sigmoid volvulus. Am J Surg 193 (4):421-426. doi:10.1016/j.amjsurg.2006.08.077
- Naseer A, Ahmad S, Naeem M, Safirullah (2010) One stage emergency resection and primary anastomosis for sigmoid volvulus. J Coll Physicians Surg Pak 20 (5):307-309. doi:05.2010/jcpsp.307309
- De U, Ghosh S (2003) Single stage primary anastomosis without colonic lavage for left-sided colonic obstruction due to acute sigmoid volvulus: a prospective study of one hundred and ninety-seven cases. ANZ J Surg 73 (6):390-392
- Sule AZ, Misauno M, Opaluwa AS, Ojo E, Obekpa PO (2007) One stage procedure in the management of acute sigmoid volvulus without colonic lavage. Surgeon 5 (5):268-270
- Raveenthiran V (2004) Restorative resection of unprepared left-colon in gangrenous vs. viable sigmoid volvulus. Int J Colorectal Dis 19 (3):258-263. doi:10.1007/s00384-003-0536-6
Corresponding Author
Dr Bishwajyoti Sahoo
Junior Resident, Dept of General Surgery, VIMSAR, Burla, Sambalpur, Odisha, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile: 7377664969
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.110
