Volvulus of the Sigmoid Colon—Management in the Surgery “A” Department of the Teaching Hospital of Point G

Introduction: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. Methodology: The study was conducted in the surgery “A” department of the Teaching Hospital of Point G in Bamako. The study is retrospective and descriptive, over 5 years, ranging from January 2014 to December 2018. We conducted a comprehensive recruitment of all patients operated on for sigmoid volvulus during the study period. The only criterion for inclusion was patients operated on for volvulus of the sigmoid colon in the surgery “A” department of the Point G Hospital and the non-inclusion criteria were all patients operated on for other sigmoid pathologies without volvulation and patients operated on for other types of occlusions. Result: We conducted an exhaustive recruitment of 55 patients operated on for sigmoid volvulus during the study period. Sigmoid volvulus accounted for 13.75% of intestinal obstructions. The average age of patients was 48.013 ± 18.042 years with extremes of 24 years and 82 years. The age group 40 49 was the most represented at 21.8%. The sex ratio (M/F) was 8 in favour of male sex. The duration of the disease was less than 1-day in 50.94% of patients. There were two cases of ileo-sigmoid nodes. Immediate anastomosis resection was performed in 27 patients or 49.2% of cases. The time to restore continuity when specified was between 60 90 days and the median incision was the most common route of recovery at 80.8% of cases. The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. Conclusion: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. The volvulus of sigmoHow to cite this paper: Keita, S., Keita, K., Sissoko, M., Coulibaly, M., Soumare, L., Sacko, O., Koumare, S., Koita, A.K., Keita, S. and Sanogo, Z. (2020) Volvulus of the Sigmoid Colon—Management in the Surgery “A” Department of the Teaching Hospital of Point G. Surgical Science, 11, 469-478. https://doi.org/10.4236/ss.2020.1112049 Received: November 10, 2020 Accepted: December 21, 2020 Published: December 24, 2020 Copyright © 2020 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access


Introduction
The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation [1]. This pathology has been known since antiquity because HIPPOCRATES already proposed as a treatment of devolvulation of the volvulated sigmoid [2]. It accounts for 3.4% of the causes of acute intestinal obstructions in the United States, 2% in Western Europe and 30% in black Africa [2]. In Mali, the frequency of sigmoid volvulus is 10.9% of acute intestinal obstructions [3]. The average age in Africa is 40 [4] compared to 70 years in Western countries [5].
The clinical diagnosis of volvulus of the sigmoid colon is based on the permanent cessation of the transit of materials and gases, diffuse abdominal pain more marked in the left flank and abdominal meteorism [4] [6] [7]. Undated abdomen X-ray is the first-line examination. It makes it possible to make the diagnosis in 90% of cases [4], by highlighting colic hydro-pneumatic levels. Water-soluble enema tends to be abandoned. It allows the contrast product to be stopped in "bird's beaks" to be objective.
These examinations do not pre-tell the vitality of the flow-through handle. Abdomino-pelvic CT scan (CT) with or without contrast injection is an important examination. It allows not only positive, etiological diagnoses but also that of severities [8].
The therapeutic attitude to be adopted urgently is controversial and uses various techniques that have evolved over recent years.
Emergency endoscopic treatment, if available, is becoming increasingly important in allowing cold surgery. This endoscopic untwist followed by sigmoidectomy after colic preparation is the ideal technique in the absence of signs of severity [7] [8] [9]. The surgical approach is varied, sometimes controversial.
In Mali, there is no validated consensus for the choice between immediate anastomosis resection if possible and multi-stage surgery. The purpose of this study is to evaluate the different surgical approaches carried out in the surgery "A" department of the Point G Hospital.

Methodology
The study was conducted in the surgery "A" department of the Teaching Hos-

Results
We procedure. There were two cases of ileo-sigmoid nodes. The sigmoid handle did not present necrosis in 74.6% of patients ( Figure 1, Figure 2). There were 11 cases of sigmoid dilation, 01 cases of perforation, 04 cases of peritoneal effusion  (Table 4). The gesture depended on the condition of the Sigmoid colon (Table 5). In 54.5% of cases the intervention did not exceed 2 hours of time.
Immediate surgical follow-ups were simple in 81.8% of cases. Up to a month, the Figure 2. Image of the sigmoid colon after sigmoidectomy/photo surgery "A" at the Point "G" Hospital. The time to restore continuity when specified was between 60 -90 days and the median incision was the most common route of recovery at 80.8% of cases.
The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. The average length of hospitalization was 9 ± 6 days (with a minimum of 2 days and a maximum of 42 days).

Discussion
The methodology adopted allowed us to carry out a retrospective study. However, we have faced difficulties, related to the retrospective nature of the study (poor preservation of archives and poor quality of data in some files). These difficulties have been reported by other authors [10]. Male predominance was noted in all authors outside of an Australian study where sex ratio was in favour of women. In Morocco [14], women would be relatively protected thanks to their wider pool. However, they are exposed to serious occlusive accidents during pregnancy, including during the third trimester, post partum or after gynecological surgery [13] [15] [16]. The sigmoid colon of man is longer and his meso narrower [7]. Today, we are seeing a significant reduction in the male-to-female relationship that tends to balance [17] [18].  [22]. The reasons for this delay in consultation are varied and related: the practice of traditional medicine, self-medication, the hope of spontaneous healing, the delay in the reference system, the low socio-economic level, and the lack of awareness [9] [23]. The majority of patients had a good general condition with a WHO grade 1 and grade 2 index or 74.6% of cases.
Clinical examination and un preparation X-ray shots of the abdomen are usually sufficient for diagnosis. The current progress in the diagnosis of sigmoid volvulus is based on the advent of emergency abdominal CT scans, which not only connects the occlusion to the volvulus of the sigmoid, but also to look for signs Immediate postoperative complications were: parietal suppuration in four of our patients, or 7.3% of the cases, one of whom had received a Bouilly-Volkmann procedure and the other three of a Hartmann-type procedure; evisceration in three of our patients, or 5.5% of the cases, of which one had benefited from a Bouilly-Volkmann procedure and the other two had a Hartmann-type procedure, one of which was complicated by a ventration; digestive fistula, a case of 1.8% and peritonitis, one case or 1.8%, They had both benefited from immediate anastomosis resection and died. The mortality associated with the volvulus of the sigmoid depends on the duration of the symptoms, the general condition of the patient, the vitality of the twisted handle and the surgical procedure performed [28]. The mortality rate ranges from 1.01% [25] to 14.5% [5]. It was 3.4% case in our series.

Conclusion
The volvulus of sigmoid is a serious surgical emergency that requires early diag-nosis and management. A common pathology in developing countries with a high-fibre diet is the preserve of relatively young subjects. On the other hand, it is rarer in developed countries where it mainly concerns elderly subjects with associated comorbidity factors. Anatomically, the existence of a dolichocolon explains the frequency of complete rotations of the sigmoid colon. Sigmoidectomy can be done in a time with immediate recovery of digestive continuity or in two stages with the making of a colostomy followed by recovery of the digestive continuity delayed by a few weeks.

Limitations
The limitations of the study were: the sample size which was small, the incomplete records of retrospective nature and the duration of the study which was short.