Sigmoid colon morphology in the population groups of Durban, South Africa, with special reference to sigmoid volvulus

Abstract

Sigmoid volvulus demonstrates geographical, racial, and gender variation. This autopsy study was undertaken to establish morphological differences of the sigmoid colon and its mesocolon in which the length and other characteristics were assessed. A total of 590 cadavers were examined (403 African, 91 Indian, and 96 White). Length and height of the sigmoid colon and mesocolon were significantly longer in Africans, and mesocolon root was significantly narrower in Africans. Mesocolic ratio for Africans, Indians, and Whites was 1.1 ± 0.8, 1.8 ± 0.7, and 1.9 ± 1.0, respectively. Africans had a significantly high incidence of redundant sigmoid colon with the long-narrow type and suprapelvic position predominating (P = 0.003); the opposite applied to the classic type. There was no difference in sigmoid colon length, mesocolon height, and width between males and females in all population groups. Among Africans, the long-narrow type was more common in males, and the classic and long-broad types were more common in females. Splaying of teniae coli and thickening of the mesentery were more common in Africans. Tethering of the sigmoid colon to the posterior abdominal wall was less common in Africans compared with other population groups. In conclusion, the sigmoid colon was longer, and the sigmoid mesocolon root was narrower in Africans compared with the other population groups, and the sigmoid colon had a suprapelvic disposition among Africans. In Africans, the sigmoid colon was longer in males with a long-narrow shape. These differences may explain geographical and racial differences in sigmoid volvulus.

Morphology of Sigmoid Colon in South Indian Population: A Cadaveric Study

“…In a radiological study done among the Calabar community in Nigeria, Bassey suggested that chronic use of enema along with the instrumentations used to deliver the concoction results in the lengthening of loop [10]. This could be responsible for a similar finding by Madiba et al, [5] belonging to the same continent.…”

“…Haffajee [5]. The classical type of sigmoid colon was the one that lies close to the pelvic brim with the normal anatomical textbook description.…”

“…Studies have shown that the sigmoid colon length was considerably more in Africans [5]. Barium enema films of patients of the same population groups were also studied by Madiba et al, and the results showed longer sigmoid loop among Africans, followed by Whites and then Indians [4].…”

“…Studies have shown that variation in the shape of mesocolon could alter the morphology of sigmoid colon [3]. In addition, the length and diameter of the sigmoid colon was found to vary in both genders [4,5] and noted to increase with age [6]. The present study aims to find the morphology of sigmoid colon in South Indian population using cadavers in view of the high incidence of sigmoid volvulus in cases of intestinal obstruction.…”

An abnormally positioned and morphologically variant sigmoid colon: case report

“…This report matches with the long-narrow type description of Madiba and Haffajee. [9] Madiba and Haffajee also classified the sigmoid colon in reference to the pelvic brim as pelvic and suprapelvic positions; [9] our case falls in to the category of suprapelvic type. Nayak et al [2] reported a case of sigmoid colon where it occupied the median position in the lesser pelvis, completely filling the rectovesical pouch and covering the superior aspect of the urinary bladder.…”