Histological evidence of hypertrophy and ischaemia in sigmoid volvulus among Africans.

OBJECTIVE

To document histological evidence of hypertrophy and ischaemia in sigmoid volvulus among Africans.

DESIGN

Retrospective case series study of the histology of sigmoid volvulus over seven years with cadaveric controls.

SETTING

King Edward VIII Teaching Hospital, University of Natal, Durban, South Africa.

SUBJECTS

Fifty African patients with sigmoid volvulus and nine cadavers with normal sigmoid colon.

RESULTS

There was hypertrophy of the submucosa, muscularis propria and nerve plexuses with features of ischaemia in the patients' specimens. Their veins were thrombosed and recanalized while mesentery and submucosa had fibrosis and vascular hyalinization. There was also hypertrophy and hyperplasia of Meissner's nerve plexus. In the autopsy study, normal African sigmoid specimen showed similar ischaemic features but specimens from the four Indian patients in the study did not have such abnormalities.

CONCLUSION

We postulate that chronic ischaemia may account for postoperative anastomosis dehiscence in some cases where the resection margins involved the hypertrophic segment. The benefit of an extended resection with anastomosis being effected on the bowel with apparent normal thickness to avoid this possibility should be investigated.