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RESECTION AND PRIMARY ANASTOMOSIS IN THE MANAGEMENT OF ACUTE SIGMOID VOLVULUS

The Pakistan journal of surgery 03/2013;

ABSTRACT Objective: To evaluate the results of resection and primary anastomosis in acute sigmoid volvulus with viable gut. Design & Duration: Prospective case series from Feb. 2002 to March 2008. Setting: Surgical Departments of District Headquarter Hospital at Abbottabad and Battagram, and AHQ Hospital at Ghallanai (Mohmand Agency). Patients: Sixty three patients with acute sigmoid volvulus with viable intestine. Methodology: All the patients underwent emergency resection and primary anastomosis, without mechanical bowel preparation. Results: Amongst the 63 patients, there were 58 males and only five females with ages ranging from 38 to 62 years (mean 56.8 years). The time between onset of symptoms and presentation to the emergency department ranged from 14-72 hours (mean 18.2 hours). There was no mortality or anastomotic leakage, but 12(19%) cases developed wound infection and one wound dehiscence. Conclusion: Resection and primary anastomosis in acute sigmoid volvulus with viable gut is a safe and cost effective, single stage procedure in emergency. The clinical pattern is universal, consisting of abdomi-nal pain, distension and constipation; vomiting is absent initially. 8,9 Digital rectal examination reveals an empty rectum. Leucocytosis and Guaiac-positive stools may indicate bowel ischemia. 1 X-ray abdomen shows a very distended sigmoid colon without haustral markings, projecting into the right upper quadrant and named as “Omega Loop” or “Coffee Bean” Sign. 1,10,11 Abdominal CT scan is confirmatory. 12 The are several options for treatment of sigmoid volvu-lus 7 including reduction by sigmoidoscopy and contrast enemas, sigmoid colopexy, mesosigmoidoplasty, sigmoid resection with Hartmann’s procedure or a double barrel colostomy. Many surgeons are now performing resection and primary anastomosis in cases of viable gut, with negligible morbidity and mortality. Hence this study was conducted to see the outcome of resection and pri-mary anstomosis in sigmoid volvulus with viable gut in our peripheral hospitals.

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    ABSTRACT: In sigmoid volvulus (SV), the sigmoid colon wraps around itself and its mesentery. SV accounts for 2% to 50% of all colonic obstructions and has an interesting geographic dispersion. SV generally affects adults, and it is more common in males. The etiology of SV is multifactorial and controversial; the main symptoms are abdominal pain, distention, and constipation, while the main signs are abdominal distention and tenderness. Routine laboratory findings are not pathognomonic: Plain abdominal X-ray radiographs show a dilated sigmoid colon and multiple small or large intestinal air-fluid levels, and abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy shows a spiral sphincter-like twist of the mucosa. The diagnosis of SV is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%.
    Eurasian Journal of Medicine. 01/2010;

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