Diagnostic laparoscopy in acute abdominal pain

Authors

  • Ravichandran Subramaniam Department of General Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Science and Research, Melmaruvathur, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191029

Keywords:

Appendisectomy, Appendicitis, Bowel perforation, Cholecystitis, Diagnostic laparoscopy

Abstract

Background: Acute Abdominal pain is an important surgical problem in all age groups. Early diagnosis is needed to rule out life threatening conditions. Diagnostic laparoscopy is a modern useful tool in giving proper treatment for all needed individuals. The aim of the present endeavor is to study the use of laparoscope in patients with acute pain over the abdomen, to diagnose and confirm conditions like acute appendicitis, appendicular abscess, doudenal perforation, ileal perforation. Ovarian torsion. mass formation, etc. where clinical and imaging studies are inconclusive.

Methods: This study was conducted in the tertiary care hospital and the Department of General Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Science and Research, Melmaruvathur. The period of study was from June 2017 to May 2018. All patients coming to the hospital with acute abdominal pain in the age group of ten years to seventy years were included in this study.

Results: Majority of the patients had the findings relevant to the correct clinical diagnosis. However significant number of patients had unexpected findings and so the diagnosis was changed, and treatment also changed. Total 100 patients were included in this prospective study. 79 patients were found to have acute appendicitis. Duodenal perforation seen in 7 patients. Jejunal perforation seen in 2 patients. Mesenteric ischemia seen in 1 patient. Acute cholecystitis seen in 3 patients. Gall bladder perforation seen in 1 patient. Ectopic pregnancy was seen in 2 patients. Ovarian torsion seen in 3 patients. Ileocecal tuberculosis seen in 1 patient. No abnormality seen in 1 patient.

Conclusions: The best approach in abdominal pain is to do diagnostic laparoscopy and proceed, rather than going for open laparotomy. Diagnostic laparoscopy gives all benefits of minimal invasive surgery. Not much of pain, shorter period of hospitalization, small scars, low infection rates and most importantly, accurate diagnosis and the correct treatment of most of the intra-abdominal conditions are the gifted things.

References

Karamanakos SN, Sdralis E, Panagiotopoulos S, Kehagias I. Laparoscopy in the emergency setting: a retrospective review of 540 patients with acute abdominal pain. Surg Laparosc Endosc Percutaneous Tech. 2010 Apr 1;20(2):119-24.

Ning N, Xia SY, Ma B, Li R, DU X. Application of laparoscopic technique in acute abdomen of gastrointestinal surgery. Chinese J Gastrointestinal Surg. 2013 Oct;16(10):960-2.

Draghici I, Draghici L, popescu M, Litescu M, laparoscopic exploration in paediatric surgery emergencies. J Med Life. 2010;3 (1):90-5.

Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, et al. Laparoscopy for abdominal emergencies. Surg Endoscopy Other Interventional Tech. 2006 Jan 1;20(1):14-29.

Agrusa A, Romano G, Di Buono G, Dafnomili A, Gulotta G. Laparoscopic approach in abdominal emergencies: a 5-year experience at a single center. J Surg. 2012;33(11/12):400-3.

Reiertsen O, Trondsen E, Bakka A, Andersen OK, Larsen S, Rosseland AR. Prospective nonrandomized study of conventional versus laparoscopic appendectomy. World J Surg. 1994 May 1;18(3):411-5.

Agresta F, Ciardo LF, Mazzarolo G, Michelet I, Orsi G, Trentin G, Bedin N. Peritonitis: laparoscopic approach. World J Emergency Surg. 2006 Dec;1(1):9.

Golash V, Willson PD, early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1,320 patients. Surg Endo. 2005 Jul; 19(7):882-5.

Gaitán HG, Reveiz L, Farquhar C, Elias VM. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. Cochrane Database Systematic Rev. 2014(5).

Lobe TE. Laparoscopic surgery in children. Cur Problems Surg. 1998 Oct 1;35(10):859-948.

Partecke LI, von Bernstorff W, Karrasch A, Cziupka K, Glitsch A, Stier A, et al. Unexpected findings on laparoscopy for suspected acute appendicitis: a pro for laparoscopic appendectomy as the standard procedure for acute appendicitis. Langenbeck's Arch Surg. 2010 Nov 1;395(8):1069-76.

Talat N, Afzal M, Ahmad S, Rasool N, Wasti AR, Saleem M. Role of diagnostic laparoscopy in evaluation and treatment of chronic abdominal pain in children: a five years data. J Ayub Med Coll Abbottabad. 2016 Mar 10;28(1):35-8.

van den Broek WT, Bijnen AB, van Eerten PV, de Ruiter P, Gouma DJ. Selective use of diagnostic laparoscopy in patients with suspected appendicitis. Surg Endosc. 2000 Oct;14(10):938-41.

Borgstein PJ, Gordijn RV, Eijsbouts QA, Cuesta MA. Acute appendicitis-a clear-cut case in men, a guessing game in young women. Surg Endosc. 1997 Sep 1;11(9):923-7.

Davies J, Goldsmith PJ, Aghahoseini A, Alexander DJ. Acute appendicitis-is there still a place for active observation?. Ann Royal Coll Surg England. 2010 May;92(4):358-9.

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Published

2019-03-26

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Original Research Articles