The twisted gut: Role of primary anastomosis without colonic lavage
Background : The twisted gut or the sigmoid volvulus has a multitude of treatment options ranging from colonic decompression to staged procedures such as primary resection anastomosis with covering colostomy followed by colostomy closure at a later date.
Objective : This study aims to evaluate the efficacy and safety of primary resection and anastomosis followed by anal dilatation without on table colonic irrigation or diversion colostomy in cases of acute sigmoid volvulus.
Methods : This study was carried out over a span of three years and seven months at a teaching hospital in West Bengal. One hundred consecutive cases of acute sigmoid volvulus who underwent primary resection and anastomosis without diversion colostomy were included in the study.
Results : There were 94 males and 6 females. The age ranged from 35 to 72 years, the majority ( 65 % ) of the patients being in the age group of 41-60 years. All the patients underwent primary resection and anastomosis without on table colonic irrigation. Superficial wound infection was detected in 18% patients.. There was no clinical anastomotic leak, intra abdominal abscess or recurrence of volvulus or mortality in our series.
Conclusion : In conclusion, primary resection and anastomosis of the colon without faecal diversion for acute sigmoid volvulus is safe and can be accomplished without any mechanical bowel preparation or on table colonic irrigation.
Ward S, Khan D, Edwards T, Daniels I. Sigmoid Volvulus : A New Twist to an Old Problem. The Internet Journal of Surgery 2010; 27 (2)
Balantyne GH. Review of sigmoid volvulus : history and results of treatment. Dis Col Rectum 1982; 25(8): 823-30
Khan M, Ullah S, Ullah Jan MA, Naseer A, Ahmad S, Rehman AU. Primary anastomosis in the management of sigmoid volvulus without colonic lavage. JPMI 2007; 21(4): 305-308
Oludiran OO, Osime OC. Emergency one- stage resection without mechanical bowel preparation for acute sigmoid volvulus. Journal of Medicine and Biomedical Research. 2004; 3(2): 86-90
Ali M, Hashmi Z, Zafar A. Management of acute sigmoid volvulus, using one stage resection and anastomosis, without colonic lavage. Gomal Journal of Medical Sciences 2009; 7(2): 101-105
Lim JF, Tang CL, Seow-Choen F, Heah SM. Prospective randomized trial comparing Intraoperative colonic irrigation with manual decompression only for obstructed left-sided colorectal cancer. Dis Colon Rectum 2005; 48: 205-9
Naraynsingh V, Rampaul R, Maharaj D, Kuruvilla T, Ramchavan K, Pouchet B. Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon. Br J Surg !999; 86: 1341-3
Hsu TC. One-stage resection and anastomosis for acute obstruction of the left colon. Dis Colon Rectum 1998; 41: 28-32
Patriti A, Contine A, Carbone E, Gulla N, Donini. One-stage resection without colonic lavage in emergency surgery of the left colon. Colorectal Disease 2005; 7: 332-8
Sule AZ, Misauno M, Opaluwa AS, Oio E. One- stage treatment of left – sided large bowel emergencies. East Afr Med J 2008; 85(2): 80-4
Naaeder SB, Archampong ED. One stage resection of acute sigmoid volvulus. Br J Surg 1995;82:1635-6
Santos JCM Jr.,Batista J, SirimarcoMt, Guimares AS, Levy CE. Prospective randomized trial of mechanical bowel preparation in patients undergoing elective
colorectal sugery. Br J Surg1994; 81:1673-6
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