Nuhu A, Jah A
Department of Surgery, University of Maiduguri Teaching Hospital, P.M.B. 1414, Maiduguri, Borno State, Nigeria.
West Afr J Med. 2010 Mar-Apr;29(2):109-12. doi: 10.4314/wajm.v29i2.68204.
Acute sigmoid volvulus is one of the commonest causes of benign large bowel obstruction. Its incidence varies considerably from one geographic area to another.
To review the management of acute sigmoid volvulus in a relatively high prevalence area.
All adult patients with acute sigmoid volvulus seen at the Royal Victoria Teaching Hospital (RVTH) Banjul, between September 2000 and January 2005 were studied. Information obtained for analysis from the records included age, sex, clinical features, test results, and outcomes.
A total of 48 patients, 45 (93.8%) males and three (6.3%) females, with a male: female ratio of 14.3:1, age range of 19 to 78 years and mean age of 45.8 +17.6 years, underwent treatment for acute sigmoid volvulus. Twenty-one (43.8%) of the patients were aged 40 to 59 years. Two (4.2%) had rectal tube detortion followed by elective sigmoidectomy and primary anastomosis on the same admission, while 24 (50%) had emergency laparotomy at which bowel decompression, one-stage resection and primary anastomosis without on-table lavage was done. The rest of the patients, 22 (45.8%) had gangrenous sigmoid colons at laparotomy and consequently had Hartmann's procedure done. Fourteen patients (29.1%) developed wound infection and five (10.4%) had prolonged ileus that was managed conservatively. There was no anastomotic leak. The mean hospital stay was 11.1 days. There were five deaths giving a mortality rate of 10.4%.
Acute sigmoid volvulus in the Gambia is almost exclusively a male disease. Sigmoid colectomy and primary anastomosis can be carried out safely in those with viable colon without on-table colonic lavage.
急性乙状结肠扭转是良性大肠梗阻最常见的病因之一。其发病率在不同地理区域差异很大。
回顾在一个发病率相对较高地区急性乙状结肠扭转的治疗情况。
对2000年9月至2005年1月期间在班珠尔皇家维多利亚教学医院（RVTH）就诊的所有成年急性乙状结肠扭转患者进行研究。从记录中获取用于分析的信息包括年龄、性别 Clinical features, test results, and outcomes.
共有48例患者接受了急性乙状结肠扭转的治疗，其中男性45例（93.8%），女性3例（6.3%），男女比例为14.3:1，年龄范围为19至78岁，平均年龄为45.8±17.6岁。21例（43.8%）患者年龄在40至59岁之间。2例（4.2%）患者通过直肠管扭转复位，随后在同一住院期间进行择期乙状结肠切除术和一期吻合术，而24例（50%）患者接受了急诊剖腹手术，术中进行了肠减压、一期切除和无术中灌洗的一期吻合术。其余22例（45.8%）患者在剖腹手术时发现乙状结肠坏死，因此进行了哈特曼手术。14例患者（29.1%）发生伤口感染，5例（10.4%）出现长时间肠梗阻，经保守治疗。无吻合口漏。平均住院天数为11.1天。死亡5例，死亡率为10.4%。
冈比亚的急性乙状结肠扭转几乎完全是男性疾病。对于结肠存活的患者，可不进行术中结肠灌洗，安全地进行乙状结肠切除术和一期吻合术。
