Adult sigmoid volvulus in West Africa: Management and outcome at principal hospital of Dakar

Abstract

Background: Sigmoid volvulus (SV) is the commonest cause of large bowel obstruction in sub Saharan Africa. However few studies have been done in our country. Our goal was to describe the presentation, management outcome of adult SV and to evaluate our therapeutic methods in a context of non availability of endoscopic decompression.Methods: It was a retrospective, descriptive review of all adult patients, admitted in the visceral surgery department of Hospital Principal of Dakar for SV, from January 2014 to August 2018. We studied demographics variables, clinical and paraclinical features, treatment and outcome. The data were entered and analyzed using Excel 2017 software and Epi-info version 7.2.2.6.Results: We collected 103 cases of SV for 86 patients, representing 45.9% of intestinal obstruction. The mean age was 54.9 years. There were 82 males and 4 females. The mean duration of symptoms was 3.8 days. The triad acute abdominal pain, inability to pass gaz and feces, abdominal meteorism was noted in 52.4%. Plain abdominal X-ray (n=55; 53.3%) showed the classical ‘coffee bean’ sign in 69%. CT scan (n=77; 74.7%) confirmed the diagnosis in 100%. It revealed signs of intestinal gangrene in 8 cases confirmed at laparotomy in 6 cases. In 4 cases imaging was not performed.Detorsion was spontaneous in 2 cases. Faucher rectal tube decompression was performed in 81 cases with a success rate of 86.4% representing 53 patients. Elective sigmoidectomy was realized in 33 patients (31 after successful rectal tube decompression, 2 after spontaneous decompression). After elective sigmoidectomy mortality and morbidity were nil.In those with successful rectal tube decompression, 7 did not have elective sigmoidectomy for comorbidities, 12 refused the elective sigmoidectomy.Emergency surgery was performed in 34 patients: 20 patients for suspicious of complicated SV, 14 patients after failure of rectal tube decompression. It was 9 (26.4%) one stage sigmoidectomy, 24 (70.5%) 2 stage sigmoidectomy, 1 surgical detorsion without pexy. Mortality and mortality after emergency surgery were respectively 8.3% and 14.7%. After 2 stage sigmoidectomy, 86.3% benefited from a restoration of digestive continuity.During the follow-up, no recurrence occurred in patients who were operated. Conclusion: SV is a middle-age man pathology in sub Saharan Africa. In uncomplicated SV rectal tube decompression followed by elective sigmoidectomy is a good option.