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Volvulus du sigmoïde (VS) sans nécrose : colectomie idéale ou résection anastomose en 2 temps ?

Sigmoid volvulus without gangrenous: primary anastomosis versus anatomosis in 2 times?

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Journal Africain d'Hépato-Gastroentérologie

Résumé

Le volvulus du sigmoïde est une urgence médicochirurgicale fréquente. Le choix entre colectomie en urgence et colectomie en 2 temps est sujet de controverse.

Objectifs

Déterminer la fréquence du VS, décrire ses aspects diagnostiques et analyser les suites opératoires.

Méthodologie

Il s’agit d’une étude rétrospective qui a porté sur 10 ans (janvier 2000 — décembre 2009). Elle a été effectuée dans le service de chirurgie générale au CHU Gabriel Touré de Bamako (Mali). Tous les malades opérés pour volvulus du sigmoïde sans nécrose ont été retenus. Les VS avec perforation intestinale ont été écartés. Au total 138 patients ont été retenus et répartis en 3 groupes:

  1. Groupe 1

    35 cas de détorsion chirurgicale suivi d’une sigmoïdectomie dans un deuxième temps.

  2. Groupe 2

    4 cas de colostomie en urgence suivi d’un rétablissement de continuité digestive dans un deuxième temps

  3. Groupe 3

    99 cas de colectomie idéale.

Résultats

Il s’agissait de116 hommes (84,06%) et 22 femmes (15,94%).l’âge moyen était de 40,14 ans. La triade de Von Wahl était présente chez 95 patients (68,84%). Quatre vingt quinze patients (68,84%) avaient à l’ASP un niveau hydroaérique en double jambage. La durée moyenne de l’intervention a été de: 50 mn pour la détorsion simple; 100 mn pour la colostomie; 105 mn pour la colectomie idéale, et 90 mn pour la sigmoïdectomie différée à froid. Les suites étaient simples chez 32 patients (91,45%) dans le groupe 1 contre 93 patients (93,93%) dans le groupe 3. Il n’avait pas de différence statistique entre les suites dans ces 2 groupes (Test de Yate p=0,90). Nous avions enregistré 3 cas de suppuration pariétale, 4 cas de fistule digestive (2,90%) qui ont tari au cours du séjour hospitalier. La mortalité a été de 2,17% soit 1 décès dans chaque groupe. Ces décès sont survenus chez des patients d’âge supérieur à 70 ans dans un tableau d’insuffisance cardiaque décompensée. La durée moyenne d’hospitalisation a été de 11,26 jours.

Conclusion

Le volvulus du sigmoïde est une urgence fréquente. La colectomie idéale ne présente pas de risque supplémentaire.

Abstract

Sigmoid volvulus is frequent in Africa. Without gangrenous primary anastomosis and anatomosis in 2 times is controversial.

Objectives

Our aims were to determine the frequency of sigmoid volvulus without gangrenous, to describe its signs and to analyze the outcomes according to the surgical procedures used.

Methodology

A retrospective study (January 2000–December 2009) was carried out in the department of general surgery at the teaching hospital Gabriel Touré in Bamako (Mali). All the patients operated for sigmoid volvulus without gangre were included. The SV with intestinal perforation were not included. On the whole 138 patients were included and divided into 3 groups:

  1. Group 1

    35 patients having undergone a surgical untwisting follow by a sigmoidectomy in the 2nd time.

  2. Group 2

    4 patients having undergone an colostomy in urgency followed by an anatomosis in the 2nd time.

  3. Group 3

    99 patients having undergone a sigmoidectomy anastomosis in urgency (ideal colectomy).

Results

They were 116 men (84.06%) and 22 women (15.94%). The mean age was 40.14 years. The triad of Von Wahl was present among 95 patients (68.84%). After standard x-ray 95 patients (68.84%) had the characteristic sign of VS. The mean duration of surgery was 50 mn for surgical untwisting; 100 mn for colostomy; 105 mn for colectomy anastomosis in emergency, and 90 mn for sigmoidectomy in 2nd. The outcomes were simple among 32 patients (91.45%) in group 1 against 93 patients (93.93%) in group 3. It did not have a statistical difference between these 2 groups (Test of Yates p=0.90). We had recorded 3 cases of wound infection, 4 cases of digestive fistula (2.90%). The Mortality was 2.17% it was 1 death in each group. These deaths occurred among patients of age higher than 70 years in with cardiac failure. The mean duration of hospitalization was 11.26 days (6–65 days).

Conclusion

The sigmoid volvulus is a common surgical urgency. It requires an early diagnosis and treatment. Resection and anastomosis in emergency does not present an additional risk.

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Authors and Affiliations

  1. Service de chirurgie générale, CHU Gabriel Touré, BP 267, Bamako, Mali

    A. Togo, L. Kanté, I. Diakité, B. T. Dembélé, A. Traoré, A. Diarra, B. Kelly, A. Kanté, I. Tounkara, B. Bengaly, B. Karembé & G. Diallo

  2. Service d’anesthésie réanimation, CHU Gabriel Touré, BP 267, Bamako, Mali

    B. Samaké

  3. Service de chirurgie pédiatrique, CHU Gabriel Touré, BP 267, Bamako, Mali

    Y. Coulibaly

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  1. A. Togo
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  2. L. Kanté
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Correspondence to A. Togo.

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Togo, A., Kanté, L., Diakité, I. et al. Volvulus du sigmoïde (VS) sans nécrose : colectomie idéale ou résection anastomose en 2 temps ?. J Afr Hepato Gastroenterol 8, 61–65 (2014). https://doi.org/10.1007/s12157-014-0517-4

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  • DOI: https://doi.org/10.1007/s12157-014-0517-4

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