The high incidence of intestinal volvulus in Iran SIGMOID VOLVULUS

The chapter dealing with intestinal volvulus in standard medical and surgical textbooks is invariably prefaced with a reference to the high incidence of volvulus of the sigmoid colon in east European, Russian, or Nordic countries at the turn of the century. This idea has so often been repeated that it has become an accepted surgical-pathological truth. The evidence, in fact, is based on relatively few, isolated reports from Scandinavia, Germany, and Russia in the early nineteen hundreds (Samson, 1889; Obalinski, 1894; Edgren, 1901; Spassokukozki, 1909; Philipowicz, 1924; Adzarow, Stopinow, Subotic, Petrow, Gjurgjewic, and Lilic, 1924; Perlmann, 1925, Kusnezoff and Poljenoff, 1926). Subsequently Gerwig in 1950, studying the incidence of sigmoid volvulus in the United States of America, alluded to the comparatively higher frequency of this condition in eastern Europe compared with that in America, namely, 7% versus 4% of obstructions, and perpetuated in the surgical literature the concept of a geographical disparity in the frequency of intestinal volvulus. No doubt socioeconomic factors, together with the overall pattern of large bowel disease in eastern Europe and the Scandinavian countries, have changed over the past decades. It would be difficult to reconstruct former conditions in these areas to verify what may in fact have been a correct observation. More recent reports do not indicate a higher than usual incidence of volvulus of the sigmoid in these countries (Sundell, 1961). The available historical evidence must be taken accordingly for what it is worth. Clinical observations over the past few years in 5Preaented at a meeting of the British Society of Gastroenterology, London, November 1968. south Iran seem to indicate that intestinal volvulus can indeed have a geographically higher incidence in some parts of the world as compared with others (Table I). Curiously enough, this discrepancy in geo-