Recurrent Sigmoid Volvulus after Sigmoidectomy: 3 Clinical Cases

Introduction: Recurrent sigmoid volvulus is a medical and surgical emergency. It is the recurrence of a twisting of the sigmoid loop around its mesenteric axis initiating an occlusion by strangulation. The risk factors of colonic volvulus are: a dolichosigmoid, a chronic constipation, a tumor, …In Western countries, recurrences of sigmoid volvulus after surgery are rare and due to a non resection of a dolicho-megacolon. Most African studies do not report any recurrence of sigmoid volvulus after sigmoidectomy. This work aims to describe three original cases of recurrence of sigmoid volvulus after sigmoidectomy recorded at the University Hospital of Brazzaville and to analyze their causes and surgical management. Clinical Observation: We studied the cases of three male patients, whose average age was 73 years, each of them having a history of chronic constipation and sigmoidectomy for sigmoid volvulus with an average delay of recurrence of 5.3 years. They all underwent emergency laparotomy for acute intestinal obstruction on scarred abdomen. The surgery permitted to unfold a recurrent volvulus of the sigmoid associated with circumferential scar fibrosis on the volvulated sigmoid loop. A second colectomy was performed. The histological results of the surgical specimens were normal for two patients and revealed signs of tissue necrosis for the third patient. The postoperative outcome was without incident for two patients. The third patient died after developing a septic shock. Conclusion: Recurrent sigmoid volvulus after sigmoidectomy is rare. The etiological factors for our three patients were incomplete sigmoidectomy during the first operation and chronic constipation.

Volvulus of the Sigmoid Colon—Management in the Surgery “A” Department of the Teaching Hospital of Point G

Introduction: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. Methodology: The study was conducted in the surgery “A” department of the Teaching Hospital of Point G in Bamako. The study is retrospective and descriptive, over 5 years, ranging from January 2014 to December 2018. We conducted a comprehensive recruitment of all patients operated on for sigmoid volvulus during the study period. The only criterion for inclusion was patients operated on for volvulus of the sigmoid colon in the surgery “A” department of the Point G Hospital and the non-inclusion criteria were all patients operated on for other sigmoid pathologies without volvulation and patients operated on for other types of occlusions. Result: We conducted an exhaustive recruitment of 55 patients operated on for sigmoid volvulus during the study period. Sigmoid volvulus accounted for 13.75% of intestinal obstructions. The average age of patients was 48.013 ± 18.042 years with extremes of 24 years and 82 years. The age group 40 - 49 was the most represented at 21.8%. The sex ratio (M/F) was 8 in favour of male sex. The duration of the disease was less than 1-day in 50.94% of patients. There were two cases of ileo-sigmoid nodes. Immediate anastomosis resection was performed in 27 patients or 49.2% of cases. The time to restore continuity when specified was between 60 - 90 days and the median incision was the most common route of recovery at 80.8% of cases. The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. Conclusion: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. The volvulus of sigmoid is a serious surgical emergency that requires early diagnosis and management. In Mali, there is no validated consensus for the choice between immediate anastomosis resection if possible and multi-stage surgery. The purpose of this study is to evaluate the different surgical approaches carried out in the surgery “A” department of the Point G Hospital.

Staged Surgery for Giant Fecaloma Complicating Idiopathic Megacolon

Fecalomas that need surgical management are uncommon. We report a rare case of giant fecaloma in a 22 years old female, with a history of constipation since childhood and an abdominal mass. Abdomen CT scan revealed a giant fecaloma filling sigmoid lumen without signs of ischemia or either complications. Laparotomy and fecaloma extraction trough colotomy was undertaken after failure of conservative measures and endoscopic removal attempt. Hirschsprung disease having been ruled out, sigmoidectomy was performed for idiopathic megacolon. Post operative course was uneventful with good functional outcomes.

Surgical outcomes and their relation to the number of prior episodes of diverticulitis

Purpose:We aimed to investigate the relationship between the number of prior episodes of diverticulitis and outcomes of sigmoid colectomy.Methods:After institutional review board approval,a retrospective review was undertaken based on records of patients who underwent sigmoid resection with anastomosis for diverticulitis between 4 May 2007 and 29 February 2012.Patients were divided into two groups:0–3 attacks(group 1)and4 attacks(group 2).Statistical analyses were performed to determine whether the groups differed on demographic,intra-operative and postoperative variables.Results:We identified 247 patients who underwent sigmoid colectomy for diverticulitis(45 open,202 laparoscopic).The two groups did not differ significantly in age,gender,American Society of Anesthesiologists score,past surgical history,body mass index,length of stay,use of a stoma or number of prior hospitalizations for diverticulitis.Group 1 had a higher rate of abscesses(30.6 vs 6.8%,P<0.001)and fistulas(19.4 vs 0.9%,P<0.001);a longer operative time(190.1 vs 166.3 min,P=0.0024);and higher rates of postoperative complications(45.8 vs 23.3%,P<0.001)and conversion(17.1 vs 4.4%,P=0.0091).The most common surgical complications in groups 1 and 2 were wound infection(35 vs 10)and ileus(20 vs 8).Based on multivariate regression analysis,4 attacks were independently correlated with a lower complication rate(odds ratio=0.512,95%confidence interval=0.266–0.987,P=0.046).Conclusions:Patients who had4 previous attacks of diverticulitis had fewer postoperative complications.