A five years retrospective hospital based study on pattern and Management outcome of acute sigmoid volvulus at mettu karl Referal hospital, oromia region, south west Ethiopia

Abstract

BACKGROUND: Sigmoid volvulus is the commonest cause of large bowel obstruction in many regions of the world. Its prevalence varies greatly geographically. In Ethiopia, the disease is the commonest cause of emergency admissions due to intestinal obstruction. However, few studies have been conducted in North West and central part of the country in general; there was no study in Mettu particularly. Objective: To assess the pattern & management outcome of acute sigmoid volvulus at MKRH, oromia region, south west Ethiopia. METHOD: A facility based retrospective cross sectional review of surgical records was obtained. Data was collected with structured questioner by three pre trained data collectors. The collected data were checked for its completeness, entered, edited, cleaned and analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0. For all statistical significance tests the cutoff value set is P<0.05. Result: one hundred thirty one patients were managed non-operatively &operatively for acute sigmoid volvulus, of which108 (82.4%) were male patients (Male to female ratio of 4.7:1). The Hospital prevalence of acute sigmoid volvulus was 27.9%. Abdominal pain, abdominal distention & inability to pass feces & flatus were invariably the main presenting compliant in 131 (100%) of patients and abdominal distention was the dominant physical finding in 131(100%) of those patients. Those patients who had viable bowel was 97(74%) & gangrenous bowel was 34(26%). Primary resection & anastomosis was done for 78/131(59.5%) and followed by Hartman’s colostomy 18/131 (13.7%). The case fatality rate of patients after primary resection & anastomosis 6.4%.Factors associated with poor outcome were female sex (p-.025), primary resection and anastomosis (p-.020) and duration of illness (p-.027). The predominant postoperative complication was wound infection in 13/102(12.7%). Conclusion & Recommendation  The Hospital prevalence was 27.9% and mortality rate of acute sigmoid volvulus4.5%.  The most common management option was primary resection & end to end anastomosis.  Increasing referral linking and community awareness for early medical seeking behavior