Retrospective Study on Pattern of Clinical Presentation and Management Outcome of Patients Operated For Sigmoid Volvulus at Jimma Medical Center, Jimma, Oromia Region, Ethiopia.

Abstract

Background: Intestinal Volvulus is a twisting of the intestine on itself and its mesentery causing an intestinal obstruction [1]. Sigmoid volvulus (SV) is a rare cause of intestinal obstruction in the United States. [10]. In Africa, sigmoid volvulus accounts for a great proportion of large bowel obstruction and is often associated with a high mortality because it affects elderly patients who may have severe co morbid conditions [4]. Ethiopia is one of the countries where sigmoid volvulus is a major cause of large bowel obstruction (91.9%) [2]. Objective:- To assess Pattern of clinical presentation and management outcome of patients operated for sigmoid volvulus at JMC, Ethiopia from September 1, 2017 to August 30, 2022 G.C Methods: Hospital based retrospective cross-sectional study was conducted among all adult patients with sigmoid volvulus operated at JMC during the study period. Data was collected by using check list from recorded documents/charts. Collected data was cleaned and entered to epidata then transported to SPSS version 26. Descriptive and analytic studies were performed. P value ≤ 0.05 with 95% confidence interval (CI) was used to interpret the findings. Results: The data of 109 (83.8%) patients who were operated for sigmoid volvulus were retrieved and analyzed. The prevalence of acute sigmoid volvulus was 65.2%. Majority of them were men (91.7%) and most patients came from rural areas 89(81.7%). Abdominal pain, distention and failure to pass feces and flatus were their main presenting feature. Of 71 patients with viable sigmoid volvulus, 28(39.4%) was operated on emergency due to failure of non operative management, 43(60.6%) had successful rectal tube deflation and subsequently managed with definitive surgery. All (34) patients with gangrenous sigmoid volvulus, eight (27.6%) patients with viable sigmoid volvulus, one (100%) patient with gangrenous ISK and one (50%) patient with viable ISK were managed by Hartman’s procedure. While the remaining patients with viable sigmoid volvulus and ISK managed by operative derotation only. There were total of seven deaths (Mortality rate – 6.4%) and the average length of hospital stay was 7 days. Conclusion: Hartman’s procedure was the common procedure for management of acute sigmoid volvulus. Mortality rate was 6.4% and higher in gangrenous sigmoid volvulus (20.6%)