[Operative mortality in sigmoid volvulus]. / Mortalidad operatoria en volvulo de sigmoides.

This retrospective analysis evaluated 123 patients with sigmoid volvulus that underwent surgery at the Belen Hospital, Trujillo, Peru, from January 1, 1967 to December 31, 1992 in an attempt to identify by univariate analysis factors of prognostic value of operative mortality. The surgical procedures performed were destortion plus colopexia (n = 19), intestinal resection with primary anastomosis (n = 69) and resection plus colostomy (n = 35) with an operative death rate of 0%, 13% and 31.4% respectively (p = 0.005). The overall operative mortality rate was of 19.4%. The following parameters were evaluated: age, sex, duration of obstruction, mean arterial pressure, leukocyte count, type of peritoneal fluid, state of the bowel and surgical technique. Analysis of post-operative mortality disclosed the following factors associated with increased mortality: age older than 40 (p = 0.008), mean arterial pressure lower than 70 mmHg (p = 0.0001), presence of purulent or fecaloid peritoneal fluid (p = 0.001) and evidence of gangrenous colon with perforation (p = 0.0001). There were no statistically significant differences in mortality rate with regard to sex, length of history and leukocyte count. Therefore, we emphasize the need to take into account these risk factors to better clarify appropriate therapy options.

[Predisposing factors, clinical picture and mortality in volvulus of the small intestine]. / Factores predisponentes, cuadro clínico y mortalidad en vólvulo de intestino delgado.

This retrospective study evaluated predisposing factors, clinical picture and the methods of treatment related to morbidity and mortality of 19 small bowel volvulus (SBV) who underwent operation at Belen Hospital (Trujillo-Peru) during the last 26 years (1966-1992). The SBV was 1.6% of all cases of intestinal obstruction in this period and 10.8% of all intestinal volvulus. The median age was of 43 +/- 20.5 years (range, 6 to 78 years) and the majority of them were between 41 and 60 years. Sixteen cases (84.2%) were men from Indian and Spanish extraction and most of them were farmers and came from the Sierra of the Department of La Libertad. Two cases (10.5%) had non-related antecedents previous surgery. In six patients (31.6%) the volvulus was less than seven day's duration and in thirty (68.4%) it was more eight day's duration with previous attacks of obstruction (median: 19.3 days, range: 17 hours to 94 days). Pain, vomiting and distention were present in almost all of these cases. The most frequent abdominal finding was distention. The location of the volvulus was: ileum, 12 cases (63.2%), root of mesentery, 4 cases (21%) and jejunum, 3 cases (15.8%). Gangrenous bowel was present in six patients (31.5) and gangrenous intestine with perforation in two cases (10.5%) who underwent resection of the involved segment with primary anastomosis. In this group one patient (5.2%) died of sepsis and the wound infection rate was of 37.5%. There was no statistically significant correlation with the duration of illness and the presence of gangrenous loops or the mortality rate (p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)