Background: Sigmoid colon volvulus (SCV) is a twist of sigmoid colon on its mesentery. Resection and Hartman’s procedure or resection and primary anastomosis is the mainstay treatment of gangrenous sigmoid colon. Colorectal anastomosis leak rate vary from 6-30% depending on risk factors. Though the problem is so common at Felege Hiwot Comprehensive Specialized Hospital (FHCSH). There is no prior study on the area which clearly depict the problem of primary resection and anastomosis related to anastomotic leak. Objective: To assess the prevalence and associated factors of anastomotic leak in sigmoid volvulus patients operated at FHCSH from January 2015 to December 2019. Methods: A cross sectional study was conducted by revising a five years patient card registry data from January 2015 to December 2019 at FHCSH and data was collected using data abstracting checklist from the information found in the medical records. Data was entered in to EPI-info 7 and exported to SPSS 23 for analysis. Basic descriptive analysis was used for describing the study population in relation to relevant variables. Result: A total of 222 patients were operated for sigmoid volvulus on emergency base in the five years period at FHCSH. Out of this primary resection and anastomosis was done for 137 patients and Hartmann’s colostomy done for the rest of 85 patients.110 patients were included in the study. As seen in the study prevalence of anastomotic leak were 10%. Conclusion: Majority of the patients were males and from rural areas the average length of hospital stay were 9.8 days and 2 patients (1.8%) died. Keywords: Sigmoid volvulus, primary resection and anastomosis, anastomotic leak