Background <p>Sigmoid volvulus (SV) is a significant gastrointestinal condition in sub-Saharan Africa, although its epidemiology and outcomes are poorly understood.</p> Objectives <p>To determine the prevalence, demographic characteristics, clinical presentation, and outcomes of SV in Malawi.</p> Methods <p>An 11-year retrospective review of patients with SV at Queen Elizabeth Central Hospital, Malawi. Patient records were analysed for demographic characteristics, clinical presentation, mode of management, and outcomes.</p> Results <p>We identified 301 cases of SV, with a prevalence of 27.3 cases per year. Males comprised 91.4% of cases, with a mean age of 51. Emergency presentations accounted for 69.8% of cases. Resection and primary anastomosis were the most common surgical procedures. The mortality rate was 11.3%, with non-viability of bowel being a significant predictor of mortality.</p> Conclusions <p>SV contributes significantly to the disease burden, particularly among middle-aged males seen in the surgical department. It presents acutely, and resection and primary anastomosis are the primary surgical approaches. Non-viability of bowel was identified as a significant predictor of mortality, emphasising the need for prompt surgical intervention.</p> Trial registration <p>Not Applicable.</p>