Acute Sigmoid Volvulus in a West African Population

BACKGROUND: Acute sigmoid volvulus is one of the commonest causes of benign large bowel obstruction. Its incidence varies considerably from one geographic area to another. OBJECTIVE: To review the management of acute sigmoid volvulus in a relatively high prevalence area. METHODS: All adult patients with acute sigmoid volvulus seen at the Royal Victoria Teaching Hospital (RVTH) Banjul; between September 2000 and January 2005 were studied. Information obtained for analysis from the records included age; sex; clinical features; test results; and outcomes. RESULTS: A total of 48 patients; 45 (93.8) males and three (6.3) females; with a male: female ratio of 14.3:1; age range of 19 to 78 years and mean age of 45.8 +17.6 years; underwent treatment for acute sigmoid volvulus. Twenty-one (43.8) of the patients were aged 40 to 59 years. Two (4.2) had rectal tube detortion followed by elective sigmoidectomy and primary anastomosis on the same admission; while 24 (50) had emergency laparotomy at which bowel decompression; onestage resection and primary anastomosis without on-table lavage was done. The rest of the patients; 22 (45.8) had gangrenous sigmoid colons at laparotomy and consequently had Hartmann's procedure done. Fourteen patients (29.1) developed wound infection and five (10.4) had prolonged ileus that was managed conservatively. There was no anastomotic leak. The mean hospital stay was 11.1 days. There were five deaths giving a mortality rate of 10.4. CONCLUSION: Acute sigmoid volvulus in the Gambia is almost exclusively a male disease. Sigmoid colectomy and primary anastomosis can be carried out safely in those with viable colon without on-table colonic lavage

[Comparing the therapeutic outcomes of arthroscopic and open synovectomy]

Deeming the very fact that synovectomy is still being performed due to various diseases of the knee joint and having no published document comparing the outcome of arthroscopic synovectomy with open synovectomy, this study was conducted at Akhtar hospital. The design was historical cohort study. All patients who underwent synovectomy of the knee joint during 1997 to 2004 and were followed up for at least two years were enrolled. Arthroscopic synovectomy were the case group and the open synovectomy were the control one. The groups were matched through their age, sex, duration of disease and follow up. Mismatched cases were excluded. The outcome of treatment was evaluated by subjective feelings, range of motion, recurrence, postoperative pain and the days of admission. Recurrence rate were more common in arthroscopic group [P<0.008]. Limitation in range of motion of the knee joint were 5 times more in open group [P<0.000]. Fisher's test showed that subjective feelings were equal in both groups [P<0.5]. Duration of in-hospital course were 9.8 days in open group and 6 days in arthroscopic group. Opioid analgesics were utilized less in the arthroscopic group [P<0.007]. This study showed that limitation of range of motion, duration of hospitalization and the use of opioid analgesics were more in open group, compared to arthroscopic group. In contrast, the arthroscopic group had more recurrence. Subjective feelings were same in both groups