DOI: http://dx.doi.org/10.18203/2349-2902.isj20200022

Role of diagnostic laparoscopy in chronic and recurrent pain abdomen

Tejaswi Jagarlamudi, Mir Mohammed Noor Ul Hassan

Abstract


Background: Chronic and recurrent abdominal pain of unknown origin represents a significant problem in surgical patients and poses a diagnostic dilemma. With advances in optics, laparoscopy allows visualisation of entire peritoneal cavity and further makes histological diagnosis possible. The rapidly increasing popularity of laparoscopy may be attributed to several factors including its applicability in both emergency and elective settings, high diagnostic yield, therapeutic management in the same setting, low patient morbidity, reduced hospital stays and expenditure. The objective of the study was to evaluate the role of diagnostic laparoscopy in chronic and recurrent pain abdomen.

Methods: We conducted a prospective descriptive study on 50 patients who suffered from chronic and recurrent pain in abdomen for more than 3 months with inconclusive clinical or radiological diagnosis. All patients were subjected to diagnostic laparoscopy and findings were noted down. Therapeutic procedures were conducted at the same setting wherever indicated. Histopathological evaluation reports were followed up.

Results: Out of 50 patients, laparoscopy established diagnosis in 44 patients, proving diagnostic efficacy at 88%. The most common finding at diagnostic laparoscopy was appendicitis (28%), followed by adhesions (24%). Other findings were tuberculosis (16%), pelvic inflammatory disease (8%), endometriosis (3%), partial torsion of ovarian cyst (4%), cholecystitis (2%). However, diagnostic laparoscopy showed normal study in 6 patients (12%). Appendicectomy followed by adhesiolysis were the most common procedures performed.

Conclusions: Recurrent appendicitis is the most common cause of chronic and recurrent pain abdomen. Diagnostic laparoscopy is a safe and effective modality for both diagnostic and therapeutic management of such patients.


Keywords


Diagnostic, Laparoscopy, Pneumoperitoneum, Appendicitis, Adhesions, Tuberculosis, Cholecystitis, Ovarian torsion, Chronic pain abdomen

Full Text:

PDF

References


Camilleri M. Management of patients with chronic abdominal pain in clinical practice. Neurogastroenterol Motil. 2006;18:499-506.

Paajanen, Hannu, Julkunen, Kristiina, Waris, Heidi, Laparoscopy in Chronic Abdominal Pain: A Prospective Nonrandomized Long-term Follow-up Study. J Clin Gastroenterol. 2005;39(2):110-4.

Townsend CO, Sletten CD, Bruce BK, Rome JD, Luedtke CA, Hodgson JE. Physical and emotional functioning of adult patients with chronic abdominal pain: Comparison with patients with chronic back pain. J Pain. 2005;6:5-83.

El-labban GM, Hokkam EN. The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain. J Minimal Access Surg. 2010;6(4):95.

Sayed ZK, Verma RA, Madhukar KP, Vaishampayan AR, Kowli MS, Vaja C. Role of diagnostic laparoscopy in chronic abdominal pain. Int J Sci Stud. 2015;3(4):31-5.

Kumar A, Sarwar MY, Pandey NK. Role of diagnostic laparoscopy in nonspecific chronic abdominal pain: experience of 100 cases. J Evol Med Dent Sci. 2013;48(2):9361-6.

Adhikari DR, Vankipuram S, Tiwari AR, Chaphekar AP, Satardey RS. Small intestinal obstruction secondary to jejunal trichobezoar removed per anum without an enterotomy: a case report. J Clin Diagnos Res. 2015;9(3):3.

Bhatia P, Gupta P, Mor D. Role of diagnostic laproscopy in chronic pelvic pain. Int J Reprod Contracept Obstet Gynecol. 2016;5(4):1152-7.

Karvande R, Kamble R, Kharade M. A study of role of diagnostic and therapeutic laparoscopy in chronic and recurrent abdominal pain. Int Surg J. 2016;3(3):1336-40.

Sinha RM. Efficacy of Diagnostic and Therapeutic Laparoscopy in Chronic Abdominal Pain - A Hospital Based Prospective Study. Int Arch BioMed Clin Res. 2016;2(3):46-8.

Thanapongsathron W, Kanjanabut B, Vaniyapong T, Thaworncharoen S. Chronic right lower quadrant abdominal pain: laparoscopic approach. JMed Assoc Thai. 2005;88(1):42-7.

Rao TU. Role of diagnostic laparoscopy in chronic abdominal conditions with uncertain diagnosis. Int Surg J. 2016;4(1):15-8.

Baria KAK. Role of laparoscopy in diagnosis and management Of chronic Abdominal pain. Indian J Sci Res. 2013;4(1):65-8.

Wolfe JHN, Behn AR, Jackson BT. Tuberculous peritonitis and role of diagnostic laparoscopy, The Lancet. 1979;313(8121):852-3.

Shayani V, Siegert C, Favia P. The Role of Laparoscopic Adhesiolysis in the Treatment of Patients with Chronic Abdominal Pain or Recurrent Bowel Obstruction. JSLS. 2002;6(2):111-4.

Dunker MS, Bemelman WA, Vijn A, Jansen FW, Peters AA, Janss RA, et al. Long-term outcomes and quality of life after laparoscopic adhesiolysis for chronic abdominal pain. J Am Assoc Gynecol Laparosc. 2004;11:36-41.