Epidemiology and Outcomes of Small Bowel Volvulus at a Tertiary Referral Hospital in Rwanda

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Abstract BackgroundSmall bowel volvulus is a rare surgical condition that presents with features of intestinal obstruction. The aim of the study was to define the epidemiology, clinical characteristics, and outcomes of small bowel volvulus at a tertiary referral hospital in Rwanda. MethodsWe conducted an observational study of patients with small bowel volvulus from January 2013 – July 2020. Data were searched from the operative database, logbooks, and the electronic medical record. ResultsA total of 75 patients were enrolled. Patients were predominantly male (n=63, 85%) and in the lowest income category (n=51, 85%). Median duration of symptoms was 3 days (interquartile range: 2, 5). Tachypnea and tachycardia were observed in 68 (91%) and 46 (61%) patients, respectively. Most patients (n=46, 67%) presented with features of peritonitis. The most commonly involved segment of bowel was ileum in 36 (49%) patients and 49 (67%) patients had gangrenous bowel. Small bowel resection was performed in 46 (64%) patients and stoma was performed in 27 (36%) patients. Overall, 39 (52%) patients had a complication. Surgical site infections were observed in 12 (16%) patients. In-hospital mortality was 21%. Median length of hospital stay was 7 days (interquartile range: 4, 10)ConclusionSmall bowel volvulus is an important consideration in patients with intestinal obstruction. The underlying etiologies are not clear but there is a significant association in being a male and having a low socio-economic status. It is important to recognize and identify small bowel volvulus to facilitate timely management and improve patient outcomes.

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