Volvulus of Colon Sigmoide in the General Surgery Department of Chu Gabriel Toure ()
1. Introduction
Sigmoid colon volvulus is a medico-surgical emergency that represents a common cause of colonic occlusion, it is characterized by strangulation of the sigmoid loop around its meso colic axis producing low mechanical occlusion [1]. Apart from this form conventionally described, the volvulus of the sigmoid colon can occur along an organoaxial axis. This form has been highlighted in the literature thanks to the diagnostic contribution of multi-detector scanners [2].
It represents 50% of intestinal obstructions in developing countries against only 5% in the West [3]. In the United States of America, it is the third leading cause of colon obstruction after cancer and diverticulosis [4]. In western countries, sigmoid colon volvulus is common in elderly subjects (after 70 years) while it is the prerogative of young adults in African countries [5] [6]. The etiology remains unknown, however, there are factors that are implicated in the occurrence of this pathology.
In Europe, pregnancy, pelvic tumor, surgery in the small pelvis associated with constipation and/or dolichocolon favor the development of the pathology [7], some psychiatric conditions (schizophrenia, senile dementia), Chagas disease for a quarter of patients in Brazil, the vegetarian diet (because of the presence in significant quantities of cellulose residues inside the intestine) [8]. In Africa, dolichocolon, food rich in non-absorbable fiber and tendency to constipation have been implicated in the occurrence of sigmoid volvulus [9]. The clinical examination, by the presence of the sign of VON WAHL: meteorism (tympanic, asymmetric, renitent) and the x-ray of the abdomen without preparation (ASP) are usually sufficient for the diagnosis.
The therapeutic attitude in emergency is controversial and calls for a variety of techniques. Emergency endoscopy, if it is available, is becoming increasingly important in Western and Maghrebian countries. Surgery remains necessary either urgently in case of failure of non-operative treatments or necrosis, or postponed due to the high rate of recurrence. In the absence of treatment, spontaneous progression, regardless of the mechanism, is towards ischemia and then necrosis of the volvulated digestive segment.
2. Objectives
To determine the hospital frequency of sigmoid colon volvulus; to write the clinical and para-clinical aspects of sigmoid colon volvulus; write down the different treatments used for the management of sigmoid colon volvulus.
3. Methodology
This was a retrospective and prospective study that took place from January 2008 to December 2020 in the General Surgery department of Gabriel Touré. The retrospective phase ran from January 2008 to December 2019 and the prospective phase from January 2020 to December 2020.
4. Results
During our study period, we collected 320 cases of patients operated on for sigmoid colon volvulus out of 7989 surgical emergencies, i.e. 3.64%; 76.92% of digestive tracts (416); 29.44% of acute intestinal obstruction (1087). In our study, the most represented age group was between 16 and 60 years old, i.e. 81.88%. The mean age was 42.6 ± 17.4 years with extremities of 16 and 90 years (Table 1). The male sex was the most represented, 89% with a sex ratio of 8.41 (Figure 1). The surgical history was found in 13.75% of our patients (Table 2). The clinic was dominated by abdominal pain (100%), meteorism (100%), and gas and matter arrest (91.3%) (Table 3). The most common radiological image found in ASP was the double leg, i.e. 74.69% of cases (Table 4). We found sigmoid necrosis in 18.13% of cases. We found an absence of necrosis in the majority of cases, i.e. 91.56% (Table 5). The operative procedure the most performed in our patients was the RACR, i.e. 75.63% of cases (Table 6). The reoperation was performed in
The most represented age group was between 16 and 60 years old, i.e. 81.88%. The mean age was 42.6 ± 17.4 years with extremities of 16 and 90 years.
The surgical history was found in 13.75% of our patients.
The clinic was dominated by abdominal pain (100%), meteorism (100%), and gas and matter arrest (91.3%).
The most performed operative procedure in our patients was RACR, i.e. 75.63% of cases.
We found sigmoid necrosis in 18.13% of cases.
The most performed operative procedure in our patients was RACR,i.e. 75.63% of cases.
We found sigmoid necrosis in 18.13% of cases.
only 5.94% of our patients. Complications were grade V in 42.55% according to the Clavin Dindo classification.
5. Comments
Our prevalence of sigmoid colon volvulus was 26.7 cases/year. This prevalence seems to be higher than those in the literature, varying from 1.9 to 15 cases/year [2] [3] [4] [5]. This geographic difference has been reported by several authors [6] [7] (Table 7).
The clinic was dominated by abdominal pain (100%), meteorism (100%), and gas and matter arrest (91.3%). This result is comparable to those of Kalli M. in Chad in 2015 [10] who reported abdominal pain (91.2%), abdominal distension (88.6%), stopping of materials and gas (73.6%) and vomiting. In our study, the radiological image most often found in the ASP was the double jamb in 239 cases, i.e. 74.69% of cases. Cissé M. [11] in 2012 and Diarra A.G. [12] in 2009 found a double-leg image respectively 65% (65 cas) and 68.8% (138 cases) in Mali. Levsky J.M. in the US toruvated 76% (21 cases) of double-jamb image in 2010 [13]. Atamanalp in Turkey found 76% (453 cases) in 2011. [8]. In our study, the most performed operative procedure was Sigmoidectomy with colorectal anastomosis in 75.63% Complications were noted in 40 patients or 12.50%. Among which the parietal suppuration the most represented with 32.50% followed by peritonitis by release in 10% of cases. This morbidity rate does not differ from those of the African and Asian series [11] [12] [14] [15] [16]. Mortality from sigmoid volvulus is relatively high. In our study, the mortality rate was 6.25% or 20 patients. Cissé M. [11] in Mali and Atamanalp in Turkey in 2013 found a mortality rate of 14% (100 patients) and 10% (40 patients), respectively.
6. Conclusion
Sigmoid volvulus is a serious surgical emergency requiring early management. Its therapeutic modalities are controversial. As endoscopic decompression is not yet feasible in our country, sigmoidectomy with one-step colorectal anastomosis represents an alternative in Mali.