E Niyirera1*, G Mukunzenkase2 and AC Chavarri3,4
1Consultant General Surgery, Department of Surgery, Shyira District Hospital, Rwanda
2Nyamata District Hospital, Rwanda
3Rwanda Military hospital, Rwanda
4Instructor in Surgery, Harvard Medical school
*Corresponding Author:E Niyirera, Consultant General Surgery, Department of Surgery, Shyira District Hospital, Rwanda.
Received: June 17, 2022; Published: July 04, 2022
Acute sigmoid volvulus is a most common surgical condition in peasant adult male farmers; it is geographically distributed but most common in low- and middle-income countries. The early management by a skilled surgeon, the best outcome. The aim of this study was to review the management characteristics and clinical outcomes of patients diagnosed with acute sigmoid volvulus in Ruhengeri referral hospital.
Objective: To identify diagnostic tool, management and outcome of acute sigmoid volvulus in the high altitude and limited resource setting.
Methods: This is a 2-year descriptive, retrospective review of all cases of sigmoid volvulus done in the Ruhengeri referral hospital located in the Northern Province in Rwanda from January 2019 to December 2020. The study population included 46 patients diagnosed with acute sigmoid volvulus either clinically or intraoperatively. Demography, diagnostic tool, intervention, clinical outcome and length of hospital stay (LOS) have been analyzed.
Results and Discussion: In our study, 46 patients were diagnosed with acute sigmoid volvulus. Of these 39 (84.8%) were males and 7 (15.2%) were females, M: F ratio was 5.6:1. We found acute sigmoid volvulus was more common in older people above 50 years (76.1%) and the more advanced age, the higher the risk. 41 (89.1%) were peasant farmers. Aside from clinical findings, the only tool used for diagnosis was Plain abdominal X-ray (93.5%). Intraoperatively, the bowels were viable in 32 patients (69.6%) and in 14 (30.4%) were not viable. The most common procedure done was Sigmoidectomy with primary end to end anastomosis in 35 patients (76.1%) followed by sigmoidectomy and colostomy in 10 patients (21.7%). Among the patients who underwent sigmoidectomy and primary end to end anastomosis the mortality rate was 22% while among those who sustained Hartmann’s procedure the mortality rate was 50%. We found that there was an association between age and outcome (P value = 0.045) and bowel viability was leading any type of procedure (P value= 0.004). The length of the hospital stay (LOS) ranged between 1 and 35 days with mean of 8 ± 6 days. There was no association between patient age and length of hospital stay.
Conclusion: Acute sigmoid volvulus is the main cause of large bowel obstruction in peasant farmers in the Northern Province of Rwanda, with males above 50 years at high risk. Sigmoidectomy and primary end to end anastomosis is the preferred management option if bowel is viable or when the patient is clinically stable.
Keywords: Sigmoid Volvulus; High Altitude; Bowel Resection; Anastomosis
Citation: E Niyirera., et al. “Management of Sigmoid Volvulus in a High-Altitude Limited Resource Setting. A 2 Years Experience Retrospective Study in the Ruhengeri Referral Hospital". Acta Scientific Gastrointestinal Disorders 5.8 (2022): 03-07.
Copyright: © 2022 E Niyirera., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.