Histological evidence of hypertrophy and ischaemia in sigmoid volvulus among Africans.
OBJECTIVE
To document histological evidence of hypertrophy and ischaemia in sigmoid volvulus among Africans.


METHODS
Retrospective case series study of the histology of sigmoid volvulus over seven years with cadaveric controls.


METHODS
King Edward VIII Teaching Hospital, University of Natal, Durban, South Africa.


METHODS
Fifty African patients with sigmoid volvulus and nine cadavers with normal sigmoid colon.


RESULTS
There was hypertrophy of the submucosa, muscularis propria and nerve plexuses with features of ischaemia in the patients' specimens. Their veins were thrombosed and recanalized while mesentery and submucosa had fibrosis and vascular hyalinization. There was also hypertrophy and hyperplasia of Meissner's nerve plexus. In the autopsy study, normal African sigmoid specimen showed similar ischaemic features but specimens from the four Indian patients in the study did not have such abnormalities.


CONCLUSIONS
We postulate that chronic ischaemia may account for postoperative anastomosis dehiscence in some cases where the resection margins involved the hypertrophic segment. The benefit of an extended resection with anastomosis being effected on the bowel with apparent normal thickness to avoid this possibility should be investigated.
Madiba
T E
TE
Department of Surgery, Faculty of Medicine, University of Natal, Congella, South Africa.
Ramdial
P K
PK
Dada
M A
MA
Mokoena
T R
TR
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002102:Cadaver; D002648:Child; D002908:Chronic Disease; D012809:Colon, Sigmoid / Q000098:blood supply*; D006801:Humans; D006984:Hypertrophy; D007415:Intestinal Obstruction / Q000150:complications* / Q000473:pathology*; D007511:Ischemia / Q000209:etiology*; D008875:Middle Aged; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000150:complications* / Q000473:pathology*; D013019:South Africa