Volvulus of Sigmoid Colon at Sikasso Hospital

The sigmoid volvulus is an acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen. It is the most common intestinal volvulus and is an absolute medical and surgical emergency. Objectives: Determine the frequency of sigmoid colon volvulus, describe clinical and para-clinical signs, describe treatment, and determine morbidity and mortality. Methodology: This was a retrospective and prospective study performed in the General Surgery Department of Sikasso. This study concerned patients admitted and operated for sigmoid volvulus from January 1, 2014 to December 31, 2017. Retrospective Phase: We have created survey cards to study the following parameters: 1) The age and the sex; 2) The clinical signs and associated defects; 3) The radiological examinations, endoscopic; 4) The established treatment whether medical, or surgical; 5) The evolution and the postoperative consequences; 6) The admission period. Prospective Phase: At the admission each patient to benefit: a complete interrogation, a complete physical examination, additional examinations including radio of the abdomen without preparation, the rate of hemoglobin and hematocrit, grouping/rhesus. Support: Our data were collected from medical records and operating records of patients in the department. Results: We collected 54 cases of sigmoid volvulus (the annual frequency was 13.5 cases for year), which accounted for 58.1% of colonic occlusions 19.6% of intestinal occlusions and 5.9% of operative operations in emergency. The average age was 47.13 with extremes of 18 and 102 years, The sex ratio is 4.40% in favor of men. Abdominal pain, vomiting, stopping of materials and gases were present in 32 (59.3%) patients. Von Wahl’s triad was present in 36 patients (66.7%), the rectal ampoule empty in 92.6%. On the X-ray of the abdomen without preparation, 70.37% of the image was recorded as a double leg. The sigmoid was necrotic in 37% of cases, and a sigmoid volvulus and How to cite this paper: Maïga, A., Bathio, T., Diassana, M., Diakité, I., Sidibé, M.B.Y., Koné, T., Saye, Z., Bah, A., Diallo, A.B., Traoré, A.A., Diallo, M., Dembélé, B.T., Saadé, O.H., Kanté, M., Konaté, M., Dembélé, S., Samaké, M., Togo, A. and Traoré, A. (2020) Volvulus of Sigmoid Colon at Sikasso Hospital. Surgical Science, 11, 15-24. https://doi.org/10.4236/ss.2020.112003 Received: August 28, 2019 Accepted: February 1, 2020 Published: February 4, 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
Sigmoid volvulus is defined by acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen [1]. This pathology was actually described for the first time in 1836 by Rokitansky [2].
It is the most common intestinal volvulus and constitutes an absolute medical-surgical emergency [3]. Its incidence reaches 50% of intestinal obstruction in developing countries, and 70% of patients are under 60 years old [4].
Diagnosis is clinically based on abdominal meteorism, stopping of material and gas, abdominal pain [5]. Radiography of the abdomen without preparation or water-soluble enema found signs in favor of sigmoid volvulus in 90% of cases [5] by the demonstration of hydro-alaeic colic levels and or beak stoppage, bird of the contrast product.
The absence of a study on this pathology at Sikasso Hospital and the problematic of the disease justified our work.

Methodology
This was a retrospective and prospective study performed in the general surgery department of Sikasso. This study concerned patients admitted from January 1, 2014 to December 31, 2017. The parameters studied were the following: age, sex, clinical signs, paraclinical, treatment, and operative follow-up.
Our data was entered on the Word 2007 software, analyzed by SPSS10FR and processed on Word and epi-info software with significant P < 0.05.

Results
We collected 54 cases of sigmoid volvulus, which accounted for 58.1% of colonic occlusions (Table 1), 19.6% of intestinal occlusions (Table 2), the annual frequency was 13.5 cases for year (Table 3), and 5.9% of operative operations in emergency.
A. Maïga et al.   The average age was 47.13 with extremes of 18 and 102 years ( Figure 1). The sex ratio is 4.40% in favor of men ( Figure 2).
On the X-ray of the abdomen without preparation, 70.37% of the image was recorded as a double leg (Table 5 and Table 6).
The sigmoid was necrotic in 37% of cases, and a sigmoid volvulus and necrotic hail in 7.4% of cases. We found a simple sigmoid volvulus in 61% of cases (Table 7).
We performed an immediate anastomosis resection in 63%, a Hartmann resection in 29.6%, an immediate anastomosis resection plus an ileostomy in 7.4%  (Table 8 and Table 9). Operative follow-up was simple in 85.2% (Table 10), with a morbidity of 11.1, and a mortality of 14.8% (Table 11).
The average age is 47.13 with the extremes of 18 -102 years. The standard deviation is 18,861.      Sigmoid volvulus without necrosis/pregnancy 1 1.9 Sigmoid volvulus with necrosis/pregnancy 1 1.9 Total 54 100 We found a simple sigmoid volvulus in 61% of cases. We performed an immediate anastomosis resection in 63% of cases.

Discussion
Sigmoid volvulus is a relatively common condition in Africa and Asia. The studies found reported hospital frequencies ranging from 9.6 to 15 cases per year [6] [7] [8] [9]. These reports seem to be superior to those published in the West It is usually complete. Our study differs from that of the Indian and Moroccan series [16] [17]. This statistical difference is due to the delay of consultation of our patients.
The asymmetrical meteorism disappears in favor of the diffuse one when the symptoms evolve a long time [5].
X-ray of the abdomen without preparation is an essential examination to confirm the diagnosis of sigmoid volvulus by showing a typical image in the form of a double-legged arch [18].
According to Deneuville in France [18] it allows diagnosis in 70% of cases.
Millat in France, Kevin in Australia, Khanna in India found conclusive rates of  [5].
The statistical difference between our series and those of the authors mentioned above [9] [12] [16] [17] [19] is due to the fact that the typical image was not found in 16 of our patients (29.63%). They presented to ASP the image of colic-like water levels (higher than wide). After a short resuscitation, all our patients were operated on. No patients underwent nonsurgical detorsion. In our study 34 (63%) patients underwent an immediate anastomosis resection, Hartmann's two-stage colectomy was performed in 16 (29.6%) patients. 4 (7.4%) operated patients. Surgical exploration had found a sigmoid volvulus and hail with necrosis. Patients underwent pelvic resection with a Bouilly Volkmann-type ileostomy, and sigmoid resection with a colo-rectal anastomosis. In the Uptal Indian series [20] [21], however, all patients (100%) underwent immediate anastomosis resection, whereas in Khanna [22], unresectated surgical detorsion was most commonly performed (55%, 3%).
The mortality associated with sigmoid volvulus is relatively high. There is no significant difference between our results and those of the Turkish, Asian and African series [3] [23]. The selected series found mortality rates ranging from 1.01% in Uptal in India [20] to 22.7% in Mehari in Eritrea [22]. The low mortality rate in Uptal is due to the early management of the one hand and the accuracy of the therapeutic indication on the other hand. In this series [24], all patients underwent immediate anastomosis resection. The perioperative mortality is a function of the duration of the symptoms, the general condition of the patient, the vitality of the twisted loop and the surgical procedure [25].

Conclusion
Sigmoid volvulus is a serious surgical emergency requiring early diagnosis and management to improve prognosis. Pre-, postoperative and postoperative resuscitation associated with immediate anastomosis resection, or resection plus Hartmann, would reduce morbidity and mortality.

Conflicts of Interest
The author declares no conflicts of interest regarding the publication of this paper.