A Study of Clinical Presentation and Outcome of Emergency Resection of Sigmoid Volvulus

Abstract

Objective: To determine the clinical presentation and outcome of emergency resection of sigmoid volvulus among patients attending the Emergency Department of Combined Military Hospital, Rawalpindi, Pakistan.

Study Design: Analytical cross-sectional.

Place and Duration of Study: Emergency Department, Combined Military Hospital, Rawalpindi, Pakistan, from Aug 2021 to Jan 2022.

Methodology: Patients aged 30 years and above, belonging to either gender, who were managed for large bowel obstruction due to acute sigmoid volvulus were enrolled and clinical symptoms, such as medical comorbidities, previous episodes of gross distension, previous abdominal surgeries, and whether bed-bound at time of admission, were noted. The outcomes, such as wound infection, intra-abdominal abscess, anastomosis leakage, bleeding from surgical site, retraction, prolapse, and/or stenosis were observed.

Results: The study enrolled 87 patients, with mean age found to be 58.24±10.81 years. There were 58(66.70%) males and 29(33.30%) females in the study sample. Resection and Hartman's procedure (n=31, 35.60%) and resection and primary anastomosis with transverse colostomy (n=23, 26.40%) were the most commonly performed operative procedures. Previous episodes of gross distention were reported by 28(32.20%) patients and previous abdominal operation by 17(19.50%) patients while bed-bound status at the time of admission was noted in 14(16.10%) patients. Wound infection was the most common complication seen in 30(34.50%) patients, followed by bleeding in 12(13.80%) patients.

Conclusion: The findings highlight the high morbidity burden of emergency management in this cohort and advocate for preventive strategies and optimized preoperative care, to mitigate risks in high-burden tertiary-level settings.