The clinicopathological picture of sigmoid volvulus resembles that in the rest of Africa in that it affects predominantly young African males. The level of the twist is at the pelvic brim. The timing of surgery, the type of anastomosis and the viability of the bowel does not influence outcome.

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Two very rare conditions, ileosigmoid knot and intra-abdominal mucormycosis, occurred sequentially in a middle-aged HIV positive male.At laparotomy for peritonitis, a gangrenous sigmoid volvulus with ileosigmoid knot was resected; 2 days later, colo-rectal continuity was restored, the distal ileum stapled and an end jejunostomy fashioned.At re-laparotomy on day 15, necrotic stomach and spleen required a total gastrectomy and splenectomy. At reoperation 2 days later, a bile leak at the oesophago-jejunostomy site was repaired. Despite this intervention he continued to deteriorate and died of multiple organ failure 4 days later.

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Background: Symptomatic femoro-popliteal disease is treated by bypass surgery or angioplasty with or without stenting. The aim of this study was to compare the results of stenting and bypass surgery with regard to limb salvage in patients with severe leg ischaemia. Methods: A total of 213 patients with femoro-popliteal disease presenting with severe claudication or critical limb ischaemia between January 2009 and December 2013 were evaluated; 118 patients (139 limbs) had stents placed and 95 patients (104 limbs) had bypass surgery. Most (60%) presented with critical limb ischaemia (rest pain 40%, tissue necrosis 20%), and the remainder with severe claudication. The treatment groups had matching risk factors. Results: The average age was 66 years and 73% were male. Tissue necrosis was found in 26% of the stent group and 12% of the bypass group (p = 0.009). In the stent group 26% had adjunctive procedures, compared to 16% in the bypass group (p = 0.138). During the one-year follow up, there were 30 stent occlusions (22%) and 18 graft occlusions (17%) (p = 0.42). There were 14 major amputations (10%) in the stent group, and 13 (13%) in the bypass group (p = 0.68). Limb salvage rate was 90% in the stent group, and 88% in the bypass group (p = 0.68). There were no peri-operative deaths in the stent group, but one in the bypass group (1%). One-year mortality rate was equal (8%) in both groups (p = 1.00). Conclusion: One-year outcome was comparable in both groups with regard to mortality, stent or graft patency and limb salvage rates.

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