Volvulus of Colon Sigmoide in the General Surgery Department of Chu Gabriel Toure

Introduction: Sigmoid colon volvulus is a medico-surgical emergency which 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]. Objective: 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. Material and methods: 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. Results: From January 2008 to December 2020, we collected 320 cases of patients operated on for sigmoid colon volvulus out of 7989 surgical emergencies over a 12-year period, or 3.64%. 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. The male sex was the most represented, 89% with a sex ratio of 8.41. 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 common radiological image found in the ASP was the double jamb, i.e. 74.69% of cases. We found sigmoid necrosis in 18.13% of cases. We found an absence of necrosis in the majority of cases, i.e. How to cite this paper: Amadou, M., Ibrahima, D., Amadou, B., Boubacar, D.A., Bathio, T., Diassana, M., Yoro, S.B., Tani, K., Adama, D.A., Amadou, T., Zakari, S., Mamadou, D., Moussa, K., Hélène, S.O., Lassana, K., Madiassa, K., Souleymane, D., Moussa, S., Tientigui, D.B., Alhassane, T. and Adégné, T. (2022) Volvulus of Colon Sigmoide in the General Surgery Department of Chu Gabriel Toure. Surgical Science, 13, 46-52. https://doi.org/10.4236/ss.2022.131008 Received: November 9, 2021 Accepted: January 25, 2022 Published: January 28, 2022 Copyright © 2022 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
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.

Objectives
To determine the hospital frequency of sigmoid colon volvulus; to write the A. Maïga et al.
clinical and para-clinical aspects of sigmoid colon volvulus; write down the different treatments used for the management of sigmoid colon volvulus.

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.

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 Total 320 100.00 The surgical history was found in 13.75% of our patients.  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.

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.  [11] in Mali and Atamanalp in Turkey in 2013 found a mortality rate of 14% (100 patients) and 10% (40 patients), respectively.

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.