Author(s): Siba Prasad Dash1, Sekh Ansar Alli2
Large gut volvulus is a common surgical emergency in many regions of the world with significant morbidity and mortality. Delay in the diagnosis and treatment can lead to serious complications such as like bowel gangrene, perforation, peritonitis and sepsis. Emergency operation is needed in acute large gut volvulus. The purpose of our study was to analyse the mode of presentations and evaluate the outcome of various methods used in surgical management with reference to primary resection and anastomosis of large gut volvulus, mainly sigmoid volvulus, as it is the commonest type encountered.
MATERIALS AND METHODS
This study was conducted in 52 patients with acute sigmoid volvulus randomly out of 214 cases of intestinal obstruction admitted to M.K.C.G. Medical College in the Department of General Surgery from July 2015 to June 2017. Laparotomy were carried out in all 52 patients, primary resection of the affected sigmoid colon with anastomosis in single layer (n=21) and double layer (n=31) were done. Outcome of the two procedures analysed in terms of mortality, postoperative complications and hospital stay.
The maximum number of cases were found in between 41 to 60 years of age and male-to-female ratio was 2.7:1. Distention of abdomen (96%) followed by constipation in 90% were common mode of presentation. Postoperative mortality rate of 6%. Common postoperative complication found to be wound infections and a chest infection. It was 27% and 25%, respectively. Mortality and morbidity associated with single layer anastomosis was lower (14.29%) compared with conventional double layer technique (22.58%).
This study demonstrated that resection and anastomosis should be done in acute sigmoid volvulus safely. Single layer extra mucosal technique is safe and desirable in clinical practice with significant advantages than standard two layer technique