Clinical Presentation, Operative Management and Outcome of Patients With Sigmoid Volvulus at the Kenyatta National Hospital

Abstract

BACKGROUND: Sigmoid Volvulus is a surgical emergency that if not managed promptly can lead to adverse outcomes. Patients typically present with abdominal pains, distension and obstipation with vomiting frequently a late presentation. Surgical management is the mainstay in management of this condition and is tailored to the clinical picture of the patient at presentation. There is a need to assess and compare the operative outcomes associated with different surgical options in order to optimize patient care. OBJECTIVE: To determine the clinical presentation, operative management and outcomes in management of patients with sigmoid volvulus at The Kenyatta National Hospital. METHOD: This was a retrospective study conducted at the Kenyatta National Hospital. Data was obtained from the medical records of patients aged 13 years and above who were diagnosed with sigmoid volvulus between January 2014 and December 2023. Convenience sampling technique was used. Data collected included patient’s demography, clinical presentation, ASA score, viability of bowel, mode of operative management and outcomes. The statistical software for social sciences version 26.0 was used to enter, code, and analyze the acquired data (SPSS 26.0). Continuous data was analyzed using means and standard deviations, whereas categorical data was analyzed using frequencies and percentages. The t test was used to compare continuous variables, while the chi square or Fischer's exact test was used to compare categorical variables. The threshold for statistical significance was set at a p value of 0.05. RESULTS: The mean age of patients was 45.6 years (SD±19.6), with ages ranging from 14 to 92 years, and 87.5% were male. The ASA classification showed 66% as ASA I, 30% as ASA II, and 4% as ASA III. Common symptoms included abdominal pain and distension, with an average duration of 5.3 days. Intra-operatively, 55% had viable bowel, and 45% had gangrenous bowel. Most patients (76.3%) underwent resection and primary anastomosis, while 23.8% had the Hartman’s procedure. Significant predictors of the Hartman’s procedure included male gender, blood on rectal exam, and gangrenous bowel. The mean hospital stay was 14 days (SD±8.7), with 91.3% having extended stays. Complications occurred in 72.5% of patients, including surgical site infections (45%) and anastomotic leaks (15%), with a mortality rate of 12.5%. Duration of vomiting, elevated WBC count, and gangrenous bowel were linked to increased complications.

CONCLUSION: The study highlighted the significant morbidity associated with sigmoid volvulus, a surgical emergency predominantly affecting males with a mean age of 45.6years. The clinical presentation commonly includes abdominal pain, distension, with a prolonged symptom duration averaging 5.3 days. Surgical intervention is crucial, with resection and primary anastomosis being the most frequently performed procedure. However, the Hartman's procedure was more likely in patients with gangrenous bowel, male gender, and presence of blood on rectal exam