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Characteristics of Intestinal Volvulus and Risk of Mortality in Malawi

  • Surgery in Low and Middle Income Countries
  • Published:
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Abstract

Background

Intestinal volvulus is a common cause of mechanical intestinal obstruction (MIO) in Africa. Sigmoid volvulus has been well characterized in both high-income and low-income countries, but there is also a predilection for small bowel volvulus in sub-Saharan Africa.

Methods

An analysis was performed of the Kamuzu Central Hospital Acute Care Surgery Registry from 2013 to 2019 on patients presenting with intestinal volvulus. Bivariate analysis was performed for covariates based on the intestinal volvulus type. Multivariate Poisson regression models estimated the relative risk of volvulus and mortality.

Results

A total of 4352 patients were captured in the registry. Overall, 1037 patients (23.8%) were diagnosed with MIO. Intestinal volvulus accounted for 499 (48.1%) of patients with MIO. Sigmoid volvulus, midgut volvulus, ileosigmoid knotting, and cecal volvulus accounted for 57.7% (n = 288), 19.8% (n = 99), 20.8% (n = 104), and 1.6% (n = 8), respectively. Mean age was 46.8 years (SD 17.2) with a male preponderance (n = 429, 86.0%) and 14.8% (n = 74) mortality. Overall, the most common operations performed were large bowel (n = 326, 74.4%) and small bowel (n = 76, 16.7%) resections with 18.0% (n = 90) ostomy formation. Upon regression modeling, the relative risk for volvulus was 2.7 times higher in men than women after controlling for season and age. There was no statistically significant difference in the relative risk of mortality based on the type of volvulus.

Conclusion

Volvulus is a significant cause of primary bowel obstruction in sub-Saharan Africa. Type of intestinal volvulus is not associated increased risk of mortality. Reasons for increases in the incidence of small bowel volvulus are still largely undetermined.

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Acknowledgements

This study was funded by the NIH Fogarty International Center (Laura Purcell, Grant #D43TW009340). We wish to thank all of our collaborators and partners at Kamuzu Central Hospital. This study was presented in part at the American College of Surgeons Clinical Congress 2019, San Francisco, CA.

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Authors and Affiliations

  1. Department of Surgery, University of North Carolina School of Medicine, 4008 Burnett Womack Building, Chapel Hill, NC, 7228, USA

    Laura N. Purcell, Rachel Reiss, Jared Gallaher, Rebecca Maine & Anthony Charles

  2. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi

    Charles Mabedi & Anthony Charles

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  1. Laura N. Purcell
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Correspondence to Anthony Charles.

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Purcell, L.N., Reiss, R., Mabedi, C. et al. Characteristics of Intestinal Volvulus and Risk of Mortality in Malawi. World J Surg 44, 2087–2093 (2020). https://doi.org/10.1007/s00268-020-05440-2

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