Sigmoid Volvulus in the Developing Countries: The Lack of Resources Might be a Blessing in Disguise

Abstract BackgroundSigmoid volvulus is the most common type of volvulus. Its epidemiological features as well as its management differ between developed and developing countries. Tis work aims to analyze the epidemiological features and to access the surgical management of sigmoid volvulus in Tunisia, which is a developing country from North Africa and where there is a paucity of information regarding sigmoid volvulus.MethodsThis is a retrospective review of 64 patients with sigmoid volvulus treated in the General Surgery department of Jendouba Hospital in Tunisia from January 2005 to December 2019. In the absence of endoscopic management, all patients underwent surgical treatment.Results:64 patients were treated for acute sigmoid volvulus. There were 54 (84.4%) men with a male to female ratio of 5.4/1. The mean age was 62 years. The classic triad of abdominal pain, abdominal distention and constipation was reported in 56 (87.5%) patients. The mean duration of symptoms was 4.2 days. The accurate preoperative diagnosis was made in 58 (90.62%) cases. Forty patients (74%) had viable bowel obstruction and all of them had resection and primary anastomosis. Sixteen patients had gangrenous bowel obstruction of which 6 patients had resection-primary anastomosis and 10 had Hartmann’s procedure. Out of the total five deaths reported, there were only two among patients who had resection-primary anastomosis for gangrenous bowel obstruction. The commonest post-operative complication was surgical site infection in 5 cases (35.71%). The median length of hospital stay following surgery was 8 days (range 5 – 18 days). None of the patients had recurrences of volvulus after median follow up of 11 months.Conclusion Although Tunisia belongs to the volvulus belt, the epidemiologic features of sigmoid volvulus are not similar to those reported in the other African countries and tend rather to be similar to those of developed countries. Our results show that the absence of non-operative treatment can be tolerable and surgical management should be advocated as much as possible.

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Stroke in a Subsaharan Nigerian Hospital—A Retrospective Study

Tropical Doctor ◽

10.1177/004947558901900104 ◽

1989 ◽

Vol 19 (1) ◽

pp. 11-14 ◽

Cited By ~ 19

Author(s):

S A Bwala

Keyword(s):

Duration Of Symptoms ◽

Female Ratio ◽

Transient Ischaemic Attacks ◽

History Of ◽

Hospital Deaths ◽

Insulin Dependent ◽

The Mean ◽

The University ◽

First Time ◽

Male To Female

The case records of 53 consecutive Nigerian inpatients with stroke in the University of Maiduguri Teaching Hospital, Maiduguri were retrospectively reviewed. The mean age at presentation was 55 years and the male to female ratio was 2.5: 1. The mean duration of symptoms before presentation was 11.1 weeks and the average duration of stay in hospital was 3 weeks. Thirty-three (63%) of the lesions were infarctive and 19 (37%) were haemorrhagic. Only 3 (6%) patients gave a history of prior transient ischaemic attacks (TIAs). Forty-two (79%) patients were hypertensive at presentation out of which 27 (64%) had the hypertension diagnosed for the first time. Four (8%) patients were non-insulin dependent diabetics. There were 11 hospital deaths (21%). Thus hypertension, more than half undiagnosed at admission, was the most common risk factor for stroke in the hospital population studied.

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SIGMOID VOLVULUS

The Professional Medical Journal ◽

10.29309/tpmj/18.4527 ◽

2018 ◽

Vol 25 (10) ◽

pp. 1562-1567

Author(s):

Ali Akbar Ghumro ◽

Altaf Hussain Ghumro ◽

Abdul Hakeem Jamali

Keyword(s):

Primary Repair ◽

Primary Anastomosis ◽

Single Layer ◽

Developed Countries ◽

Large Bowel Obstruction ◽

Sigmoid Volvulus ◽

High Morbidity ◽

Female Ratio ◽

Male Female Ratio ◽

Medical University

Introduction: Sigmoid volvulus is the surgical emergency and significant causeof large bowel obstruction in with high morbidity and mortality. Disease is more prevalent indeveloping countries than developed countries. It contributes 15% of total bowel obstruction.Resection and primary anastomosis is the procedure of choice. It obviates the need ofcolostomy and subsequent reversal. Objectives: To determine the frequency of postoperativecomplications of primary repair in patients with either viable or gangrenous sigmoid volvulus.Study Design: Retrospective study. Setting: Surgical Unit 1 of Peoples Medical CollegeHospital now Medical University. Period: 2007 to Dec. 2013. Methodology: Patients with largebowel obstruction suspected to have sigmoid volvulus on clinical and radiological grounds werestudied. Laparotomy and resection of sigmoid colon followed by restoration of the continuity ofthe colon by single layer primary anastomosis were performed without colostomy. Results: In atotal 50 patients, sigmoid volvulus male female ratio was 9:1. Mean age was 49 years majority ofthe patients were in 6th to 7th decade of age. In 96% cases abdominal pain was the 1st symptomfollowed by constipation and distention, vomiting was the rare symptom. Different postoperativecomplication results were surgical site infection was the commonest complication in 40 (80%)while in 1 (2%) leak was there with mortality of only 1(2%) case. Conclusion: Primary resectionand single stage anastomosis is the best choice for the management of sigmoid volvulusdisease in both possibilities of viable or non viable gut provided patients condition is stable. Itobviates the burden of colostomy

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Magnitude and Clinical characteristics of Sigmoid Volvulus

10.21203/rs.3.rs-29801/v1 ◽

2020 ◽

Author(s):

Atalel Fentahun Awedew ◽

Bedemariam Tadesse Amsalu ◽

woldemariam Beka Belay ◽

Dawit Zerihun Yalewu

Keyword(s):

Logistic Regression ◽

Hospital Stay ◽

Bowel Obstruction ◽

Large Bowel ◽

Clinical Characteristics ◽

Statistical Significance ◽

Large Bowel Obstruction ◽

Sigmoid Volvulus ◽

Outcome Variable ◽

The Mean

Abstract Background: Sigmoid volvulus is a major cause of mechanical large bowel obstruction in volvulus belt countries. The objective of this study to explore the magnitude and clinical characteristics of Sigmoid Volvulus Methods: Hospital-based retrospective cross-sectional study employed in Debre Tabor general hospital Northcentral Ethiopia. A medical review conducted on the medical chart from Jan1, 2016 to Dec31, 2019. The collected data checked manually for completeness and consistency. The final data coded and entered to SPSS version 23 for data processing and analysis. Binary logistic regression used to measure the association of each covariate with the outcome variable. In addition, factors that have p=0.25 with the outcome variables were taken into a multivariable logistic regression analysis to control the potential confounders. The result of the final model expressed in terms of adjusted Odd Ratios (AOR) and 95% CI and statistical significance declared if the P-value is less than 0.05.Result: There were 124 patients with sigmoid volvulus admitted within four years of the study. During the study period, 408 patients with bowel obstructions were admitted, among Mechanical large bowel obstruction (MLBO) 135 (33.1%), Mechanical small bowel obstruction (MSBO) 251(61.5%), and Ileosigmoid knotting 22(5.4%). Our study showed that sigmoid volvulus accounted for 91.9% and 30.4% of Mechanical Large bowel obstruction and Bowel obstruction respectively. Most of the patients were male 97.6 %( N=121) and rural residents 91.1 %( N=113). The peak age was 56-65 years accounted for 29 % and 65.3 %( N=81) of patients were above age 50years. The age ranged from 19-88 years. The mean and median ages were 56.52± (SD=14.4) and 58.5± (IQR=17.75) respectively. The mean of hospital stay for elective admission was 10.98(SD±4.33) days and the median was 11 (IQR±5) days. The mean of hospital stay for emergency admission excluding death and leave against medical advice was 8.4(SD±4.1) days and median was 8 (IQR±2) days Conclusion: Primary resection and anastomosis was the common procedure for management of sigmoid volvulus. Mortality rate was 6.45% and higher in gangrenous sigmoid volvulus (14.6 % vs. 2.4%)

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Magnitude and Clinical characteristics of Sigmoid Volvulus

10.21203/rs.3.rs-29801/v2 ◽

2020 ◽

Author(s):

Atalel Fentahun Awedew ◽

Bedemariam Tadesse Amsalu ◽

woldemariam Beka Belay ◽

Dawit Zerihun Yalewu

Keyword(s):

Logistic Regression ◽

Hospital Stay ◽

Bowel Obstruction ◽

Large Bowel ◽

Clinical Characteristics ◽

Statistical Significance ◽

Large Bowel Obstruction ◽

Sigmoid Volvulus ◽

Outcome Variable ◽

The Mean

Abstract Background: Sigmoid volvulus is a major cause of mechanical large bowel obstruction in volvulus belt countries. The objective of this study to explore the magnitude and clinical characteristics of Sigmoid Volvulus Methods: Hospital-based retrospective cross-sectional study employed in Debre Tabor general hospital Northcentral Ethiopia. A medical review conducted on the medical chart from Jan1, 2016 to Dec31, 2019. The collected data checked manually for completeness and consistency. The final data coded and entered to SPSS version 23 for data processing and analysis. Binary logistic regression used to measure the association of each covariate with the outcome variable. In addition, factors that have p=0.25 with the outcome variables were taken into a multivariable logistic regression analysis to control the potential confounders. The result of the final model expressed in terms of adjusted Odd Ratios (AOR) and 95% CI and statistical significance declared if the P-value is less than 0.05. Result: There were 124 patients with sigmoid volvulus admitted within four years of the study. During the study period, 408 patients with bowel obstructions were admitted, among Mechanical large bowel obstruction (MLBO) 135 (33.1%), Mechanical small bowel obstruction (MSBO) 251(61.5%), and Ileosigmoid knotting 22(5.4%). Our study showed that sigmoid volvulus accounted for 91.9% and 30.4% of Mechanical Large bowel obstruction and Bowel obstruction respectively. Most of the patients were male 97.6 %( N=121) and rural residents 91.1 %( N=113). The peak age was 56-65 years accounted for 29 % and 65.3 %( N=81) of patients were above age 50years. The age ranged from 19-88 years. The mean and median ages were 56.52± (SD=14.4) and 58.5± (IQR=17.75) respectively. The mean of hospital stay for elective admission was 10.98(SD±4.33) days and the median was 11 (IQR±5) days. The mean of hospital stay for emergency admission excluding death and leave against medical advice was 8.4(SD±4.1) days and median was 8 (IQR±2) days Conclusion: Primary resection and anastomosis was the common procedure for management of sigmoid volvulus. Mortality rate was 6.45% and higher in gangrenous sigmoid volvulus (14.6 % vs. 2.4%)

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Early experience with ultrasound guided pneumatic reduction of intussusception using locally assembled equipment in Nepal

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v22i2.28741 ◽

2019 ◽

Vol 22 (2) ◽

pp. 27-31

Author(s):

Suman Bikram Adhikari

Keyword(s):

Bowel Perforation ◽

Pressure Gauge ◽

Intraluminal Pressure ◽

Invasive Technique ◽

Duration Of Symptoms ◽

Female Ratio ◽

Hydrostatic Reduction ◽

Pneumatic Reduction ◽

Male Female Ratio ◽

The Mean

Introduction: Intussusception is one of the commonest emergency conditions in children. Pneumatic reduction of intussusception, a minimally invasive technique, has a higher success rate and lower incidence of complications as compared to barium enema & hydrostatic reduction and also omits the need for unnecessary laparotomy. The aim of this study was to evaluate the results of the pneumatic reduction in our hospital as a treatment of idiopathic pediatric ileocolic intussusception and to identify the pretreatment factors associated with pneumatic reduction failure. Methods: This was a prospective analytical study. A total of 12 children were enrolled in the study between January to November 2018 at Nepal National Hospital, Kathmandu. Patients were given air enema under Ultrasound-guidance, using locally assembled equipment. All procedures were performed under intravenous anesthesia. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 100 mmHg. A total of three attempts of 3 minutes each were allowed. Results: Average age of the patients was 2.7 years, with a male-female ratio of 3:1. Eleven (92%) of the cases were successfully reduced while 1 (8%) case failed to reduce. No bowel perforation occurred in this study. The mean duration of symptoms before presentation was 42 hours. The mean length of intussusceptum was 3.058 cm. the mean duration of pneumatic reduction was 1.97 minutes and total intervention time i.e. from induction of anesthesia to reversal from anesthesia was 18.55 minutes. Conclusion: The technique described is easy to assemble, safe and effective. I recommend it for regular use in pneumatic reduction of intussusception, especially in centers with limited resources.

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5967A randomized trial of yoga therapy for reflex syncope

European Heart Journal ◽

10.1093/eurheartj/ehz746.0108 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S I Sinam ◽

R S Gangwar ◽

B Banavalikar ◽

D Padmanabhan ◽

V Gangwar ◽

...

Keyword(s):

Quality Of Life ◽

Tilt Test ◽

Duration Of Symptoms ◽

Female Ratio ◽

Yoga Therapy ◽

Reflex Syncope ◽

The Mean ◽

Group 2 ◽

Group 1

Abstract Background Reflex syncope (RS), the most common cause of syncope is usually recurrent, associated with decreased quality of life, and frustrates both the clinicians and the patients with a paucity of effective treatment options. Purpose To assess the effectiveness of yoga therapy on the recurrence of reflex syncope. Methods Subjects with recurrent RS (>3 episodes) and positive head-up tilt test were enrolled prospectively, and randomized to conventional therapy with physical maneuvres (Group 1) and yoga therapy (Group 2). Group 1 patients were taught physical counter-pressure maneuvers as per guidelines. Group 2 patients were taught yoga for 7 sessions by a certified Yoga instructor/therapist, and then advised to perform yoga for 60 minutes at least five days/week for six months. The Yoga module consisted of Pranayama (breathing techniques), Asanas (Postures) and Dhyana (Meditation) for 60 minutes/session. Both groups were followed up monthly for 6 months in the syncope clinic noting down the recurrences and the quality of life using the syncope functional status questionnaire score. Result The study group consisted of 97 patients (group 1: 46 patients and group 2: 51 patients) enrolled prospectively between June 2015 to February 2017. The mean age was 33.1±16.6 years, with male: female ratio 1.1:1, and a mean of 6.4±6.06 syncope episodes (group 1: 6.8±8.0 vs. group 2: 6.0±4.0; p=0.551). The mean duration of symptoms was 17.1±20.71 months (group 1: 16.1±22.8 months vs. group 2: 17.8±19.1 months; p=0.694). There was a significant decrease in the recurrences of syncope in the yoga group compared to the conventional group at three months (group 1: 1.8±1.4 vs group 2: 0.8±0.9, P<0.001) as well as six months follow-up (group 1: 3.38±3.0 vs group 2: 0.98±1.23, P<0.001). The quality of life score at 6 months improved in 20 patients in group 1 and in 45 patients in group 2 (<0.001). Conclusion Guided yoga therapy is superior to conventional measures in reducing the number of syncopal episodes and improves the quality of life in patients with reflex syncope. Yoga therapy should be considered as treatment strategy for patients with reflex syncope.

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Is single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage a safe procedure?

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.06.6017 ◽

2021 ◽

Vol 28 (06) ◽

pp. 872-875

Author(s):

Muhammad Bilal ◽

Viqar Aslam ◽

Waqas Jan ◽

Zaheer Udin

Keyword(s):

Primary Anastomosis ◽

Mechanical Bowel Preparation ◽

Sigmoid Volvulus ◽

Single Stage ◽

Safe Procedure ◽

Local Data ◽

Cross Sectional ◽

Female Ratio ◽

Colonic Lavage ◽

Resection And Anastomosis

Objective. This study was conducted to provide local data regarding the results and post-operative complications after single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage. Study Design: Descriptive Cross Sectional. Setting: DHQ Charsadda. Period: May 2017 to December 2019. Material & Methods: This clinical study was done on 50 patients who presented with the signs and symptoms of acute sigmoid volvulus excluding those with complications of the illness such as gangrene, perforation and peritonitis. Surgery for all patients was carried out under General anaesthesia. All the patients underwent emergency resection and primary anastomosis, without mechanical bowel preparation. Data were collected regarding post operation complication and analysis by using SPSS version 23. Chi square test was used to compare at level of significance <0.005. Results: Median age of patients was 50 years with male to female ratio 5:3. Seven patients presented with wound infection, one dehiscence while zero Anastomotic leakage and zero death postoperative recorded. Conclusion: Single stage resection and primary anastomosis without preoperative colonic lavage for acute sigmoid volvulus is a simpler and short procedure with low mortality and morbidity rates.

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Gastrointestinal Perforation by Ingested Foreign Bodies: Experience at A Surgical Department in Tunisia

10.21203/rs.3.rs-152232/v1 ◽

2021 ◽

Author(s):

Atef MEJRI ◽

Emna Trigui ◽

sarra saad ◽

jasser yaacoubi ◽

skander mrad ◽

...

Keyword(s):

Foreign Body ◽

Hospital Stay ◽

Foreign Bodies ◽

Length Of Hospital Stay ◽

Gastrointestinal Perforation ◽

Duration Of Symptoms ◽

Female Ratio ◽

Surgical Department ◽

Low Middle Income Countries ◽

The Mean

Abstract Background Management of gastrointestinal perforation by ingested foreign bodies remains a topical subject following technological progress. This work aims to analyze, the epidemiological features, the management in a Tunisian surgical department and to access the most realistic and beneficial management of gastrointestinal perforation by ingested foreign bodies in a low-income country, where there is a paucity of information regarding this subject Methods This is a retrospective review of 24 patients with gastrointestinal perforation by ingested foreign bodies treated in the General Surgery department of Jendouba Hospital in Tunisia from January 2010 to December 2019. Results 24 patients with gastrointestinal tract perforation by an ingested foreign body were managed at our surgical ward. The mean age of patients was 56.58 years with extreme ranging 25-72 years with a male to female ratio 2/1. Three patients (12.5%) had psychiatric disorder, one had myasthenia (4.1%), two patients were alcoholics (8.33%), three patients were toothless (12.5%) and two (8.33%) patients were veiled. According to ASA classification, 6 (25%) patients were ASA I, 15 (62.5%) patients ASA II, 3 (12.5%) ASA III. The mean duration of symptoms was 2.16 days and ranges from 1 to 7 days. All patients (100%) presented to the emergency department with acute abdominal pain. Sixteen patients (66.66%) had a fever, twelve (50%) had vomiting and four (16.66%) had a sub-occlusive syndrome. All patients had performed abdominal x-ray. The foreign bodies were objectified in only six cases (25%). CT scan was performed in 16 (66.66%) patients and the location of ingested foreign bodies was obtained in 9 patients preoperatively (37.5%) and in 4 patients (16.66%) after proofreading. All the 24 patients underwent surgery and they were operated during their initial hospital stay. The most common site of perforation was the terminal ileum (62,5%) followed by the duodenum (12, 5%). Enterectomy was the procedure of choice in 20 patients (16 underwent an enterostomy and 4 patients underwent an enteroanastomosis) and four patients had a simple suture. The foreign body was found in all patients. Two patients developed postoperative complications: one case of intraabdominal abscess and one patient had a wound dehiscence . The median length of hospital stay following surgery was 4.08 days (range 2-7 days). The mortality rate was 4.16 %. All patients managed with enterostomy, had their stoma closed after 3-5 months. Conclusion Open Surgery still remains a management with satisfactory morbidity, mortality and length of hospital stay. However, we estimate that for low/middle-income countries, investing in laparoscopy, for these cases, would be more realistic and more beneficial allowing improving more the outcomes. For this fact, promoting radiologic diagnosis is highly recommended in order to increase prospective identification of the foreign body location and perforation site, allowing a safe laparoscopic approach.

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Clinical profile of retinoblastoma presenting in a tertiary care hospital, eastern Nepal

Health Renaissance ◽

10.3126/hren.v13i3.17936 ◽

2017 ◽

Vol 13 (3) ◽

pp. 129-136

Author(s):

Poonam Lavaju ◽

BP Badhu ◽

S Shah ◽

SK Chaudhary ◽

P Upadhyaya

Keyword(s):

Optic Nerve ◽

Tertiary Care ◽

Clinical Profile ◽

Care Hospital ◽

Duration Of Symptoms ◽

Female Ratio ◽

Mode Of Presentation ◽

The Mean ◽

Clinical Records

Background: Retinoblastoma is the commonest primary intraocular malignancy of childhood. Under-standing the different modes of presentation with timely intervention are associated with prognosis.Objective: To determine the clinical profile of retinoblastoma and its association with optic nerve infiltration by tumor. Methods: A retrospective analysis of the clinical records and histopathological reports of patients admitted with retinoblastoma in a tertiary heath care center, eastern Nepal (June 2009 to July 2012) was carried out.Results: A total of 27 patients (28 eyes) with retinoblastoma were studied. The mean age at presentation was 2.89 ± 0.93 years. The mean duration of symptoms to presentation was 3.35 month, ranged from 7 days to 2 years. Male to female ratio was 3:2. Thirty-three percent patients were Muslims. Twentyseven patients (96.3%) had unilateral eye involvement. The commonest mode of presentation was leukocoria in 23 eyes (85.2%) followed by redness 9 eyes (33.3%), proptosis in 5 eyes (18.5%) and phthisis bulbi in one eye (3.7%). Histopathological reports of 26 eyes confirmed the diagnosis of retinoblastoma. One patient with distant metastases was referred to oncology center. Infiltration of the optic nerve by tumor cells was seen in five eyes (18.5%); of which two cases had proptosis (p-0.166). At two years follow up, recurrence was seen in one patient with proptosis and optic nerve infiltration (p-0.136). Age at presentation was positively associated with recurrence of tumor (p-0.005).Conclusion: Leucokoria was the most common mode of presentation of retinoblastoma. Larger sample size with longer follow up is required to come to a definite association with optic nerve infiltration by tumor. Health Renaissance 2015;13 (3): 129-136

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Our experience with Amyand’s hernia

International Surgery Journal ◽

10.18203/2349-2902.isj20195436 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4572

Author(s):

Brajesh Gupta ◽

Ghanshyam Hatwar ◽

Charu Tiwari ◽

Shweta Gupta

Keyword(s):

Inguinal Hernia ◽

Clinical Presentation ◽

Amyand’S Hernia ◽

Rare Type ◽

Duration Of Symptoms ◽

Female Ratio ◽

Duration Of Hospital Stay ◽

The Mean ◽

One Year

Amyand’s hernia is a rare type of inguinal hernia with appendix as its content, which may be normal or pathological. We present our experience with Amyand’s hernia in 6 patients. A retrospective review of 6 cases with Amyand’s hernia that were managed over a 2-year period was done by reviewing the hospital records. The variables assessed and analyzed were demographic details, clinical presentation, management and follow-up. There were 4 children and 2 adults; male and female ratio being 5:1. The mean age of four children was 1.5 years; the two adults were 72 and 54 years of age. The duration of symptoms of inguinal hernia ranged from 1 month to one year; mean duration of irreducibility was 5.33 days (range: 2 days to 15 days). Five patients had symptoms of obstruction. All 5 patients with obstruction underwent emergency surgery. The sixth patient was posted for elective hernioplasty the next day. Appendix was inflamed only in one patient. The post-operative course was uneventful in all patients. The mean duration of hospital stay was 3.33 days. Only one patient had surgical site infection. Amyand’s hernia, thus presents with features of incarcerated right hernia. Pre-operative diagnosis is difficult. Intra-operatively, the surgical procedure needs to be individualized depending upon the pathology.

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