Department of Surgery, University of North Carolina School of Medicine, 4008 Burnett Womack Building, Chapel Hill, NC, 7228, USA.
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
World J Surg. 2020 Jul;44(7):2087-2093. doi: 10.1007/s00268-020-05440-2.
Intestinal volvulus is a common cause of mechanical intestinal obstruction (MIO) in Africa. Sigmoid volvulus has been well characterized in both high-income and low-income countries, but there is also a predilection for small bowel volvulus in sub-Saharan Africa.
An analysis was performed of the Kamuzu Central Hospital Acute Care Surgery Registry from 2013 to 2019 on patients presenting with intestinal volvulus. Bivariate analysis was performed for covariates based on the intestinal volvulus type. Multivariate Poisson regression models estimated the relative risk of volvulus and mortality.
A total of 4352 patients were captured in the registry. Overall, 1037 patients (23.8%) were diagnosed with MIO. Intestinal volvulus accounted for 499 (48.1%) of patients with MIO. Sigmoid volvulus, midgut volvulus, ileosigmoid knotting, and cecal volvulus accounted for 57.7% (n = 288), 19.8% (n = 99), 20.8% (n = 104), and 1.6% (n = 8), respectively. Mean age was 46.8 years (SD 17.2) with a male preponderance (n = 429, 86.0%) and 14.8% (n = 74) mortality. Overall, the most common operations performed were large bowel (n = 326, 74.4%) and small bowel (n = 76, 16.7%) resections with 18.0% (n = 90) ostomy formation. Upon regression modeling, the relative risk for volvulus was 2.7 times higher in men than women after controlling for season and age. There was no statistically significant difference in the relative risk of mortality based on the type of volvulus.
Volvulus is a significant cause of primary bowel obstruction in sub-Saharan Africa. Type of intestinal volvulus is not associated increased risk of mortality. Reasons for increases in the incidence of small bowel volvulus are still largely undetermined.
肠扭转是非洲机械性肠梗阻（MIO）的常见原因。乙状结肠扭转在高收入和低收入国家都有很好的特征，但在撒哈拉以南非洲也有小肠扭转的倾向。
对 2013 年至 2019 年期间因肠扭转就诊于卡姆祖中央医院急症外科登记处的患者进行了分析。根据肠扭转的类型，对协变量进行了双变量分析。多变量泊松回归模型估计了扭转和死亡率的相对风险。
该登记处共收录了 4352 例患者。总体而言，1037 例（23.8%）患者被诊断为 MIO。肠扭转占 MIO 患者的 499 例（48.1%）。乙状结肠扭转、中肠扭转、回肠乙状结肠结和盲肠扭转分别占 57.7%（n=288）、19.8%（n=99）、20.8%（n=104）和 1.6%（n=8）。平均年龄为 46.8 岁（标准差 17.2），男性居多（n=429，86.0%），死亡率为 14.8%（n=74）。总体而言，最常见的手术是大肠（n=326，74.4%）和小肠（n=76，16.7%）切除术，18.0%（n=90）形成肠造口术。在回归模型中，在控制季节和年龄后，男性发生扭转的相对风险是女性的 2.7 倍。基于扭转的类型，死亡率的相对风险没有统计学意义。
扭转是撒哈拉以南非洲原发性肠阻塞的一个重要原因。肠扭转的类型与死亡率增加的风险无关。小肠扭转发病率增加的原因在很大程度上仍未确定。
