Yonas Yilma Raru,Patricia R Messmer*,Arthur R Williams,Dawood H Sultan,Ashenafi Berhanu Adale,Yalelet Fentaw Shiferaw,Paul Hart,Hugh Pettigrew
Background: Although very common in developing regions like Africa, sigmoid volvulus (SV) has a much lower incidence in the West. There is a dearth of literature on the treatment of SV in countries with limited resources. This paper reports study results using a cohort of 200 SV patients in a low-income developing country.
Objectives: The aim of this study was to identify the characteristics associated with length of hospital stay (LOS) in the largest sample of sigmoid volvulus patients drawn from a single site within a single year and to examine the effects of treatment complications and previous attacks of SV on LOS.
Methods: Data from charts for a retrospective sample of 200 adult SV patients hospitalized in 2012 at Gondar University Hospital, Ethiopia, were statistically analyzed to determine LOS by patient characteristics and the effects of complications on LOS. Results: Among the 200 patients diagnosed with SV, the ratio of deflation to surgery was almost 2:1 ratio to surgery. The total patient days in the study were 856 days. Patients with LOS > 5 days accounted for 79% of patient days. Patients with a maximum LOS of 30 days accounted for 10.5% of total patient days. The shortest LOS (1.36 days) was among patients who underwent sigmoidoscopic decompression only and had no treatment complications. Complications associated with surgery accounted for 10.6 to 17.0 LOS days. Age, gender, gangrene and previous attacks were not significantly associated with surgery. Among the study patients, there were only five cases of failed deflation followed by surgery. All but five of the patients with gangrene had surgery. Shock, stroke, abscess, sepsis and surgery significantly prolonged LOS. Patients (66%) had not experienced previous attacks. SV affected middle aged men more than the elderly men. Females had an excess relative risk (RR=1.62) for surgery but was not statistically significant due to the small number of females (n=15) in the study.
Conclusion: Deflation was an effective treatment modality, while surgery was performed only when indicated and only on the critical cases. Patients who are treated with deflation may avoid surgery which can be associated with additional complications. Avoidance of surgery and complications can substantially reduce LOS with subsequent and system costs.