Bedside diagnostic laparoscopy for critically ill patients: a retrospective study of 62 patients

Ceribelli, Cecilia; E, Adami; Mattia, S.; Benini, Bruno

doi:10.1007/s00464-012-2383-4

Cited by 24 publications

(23 citation statements)

References 19 publications

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“…Evaluation of acute abdominal conditions in critically ill patients is often unreliable due to the patient's sedation and analgesic medication, inability to communicate, or intubation. 5 Delay in suspecting and diagnosing acute abdominal conditions can lead to serious and fatal consequences. 5 Over the past 30 years, CT has emerged as the technique of choice in most patients with acute abdomen.…”

Section: Discussionmentioning

confidence: 99%

“…5 Delay in suspecting and diagnosing acute abdominal conditions can lead to serious and fatal consequences. 5 Over the past 30 years, CT has emerged as the technique of choice in most patients with acute abdomen. However, there is a lack of studies showing the overall impact of CT on the management of critically ill patients, and its capacity to avoid nontherapeutic surgical exploration.…”

Section: Discussionmentioning

confidence: 99%

“…An additional risk when one leads with critically ill patients is to deny a negative CT or to overestimate CT findings. 5,15,16 Some authors advocate the use of bedside diagnostic laparoscopy for diagnosing abdominal diseases in ICU patients. 5,17,18 These studies reported a high diagnostic accuracy for intra-abdominal diseases, especially acute acalculous cholecystitis, but not for pancreatitis, retroperitoneal or innercavity diseases.…”

Section: Discussionmentioning

confidence: 99%

“…5,15,16 Some authors advocate the use of bedside diagnostic laparoscopy for diagnosing abdominal diseases in ICU patients. 5,17,18 These studies reported a high diagnostic accuracy for intra-abdominal diseases, especially acute acalculous cholecystitis, but not for pancreatitis, retroperitoneal or innercavity diseases. 19 It is limited by the availability of an optimal operating-room-like environment in the ICU, and daily emergency and laparoscopic surgical technical skills of surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…5 Computed tomography (CT) scans are increasingly used for emergency patients with acute nontraumatic abdominal pain and tenderness, however, misinterpretation or overinterpretation of CT findings are not rare. 6,7 Despite the large use of imaging procedures in the evaluation of intra-abdominal pathologies, few studies have attempted to assess their impact on the management of critically ill patients.…”

mentioning

confidence: 99%

See 4 more Smart Citations

How to Avoid Nontherapeutic Laparotomy in Patients With Multiple Organ Failure of Unknown Origin. The Role of CT Scan Revisited

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Diagnosis of intra-abdominal diseases in critically ill patients remains a clinical challenge. Physical examination is unreliable whereas exploratory laparotomy may aggravate patient's condition and delay further evaluation. Only a few studies have investigated the place of computed tomography (CT) on this hazardous situation. We aimed to evaluate the ability of CT to prevent unnecessary laparotomy during the management of critically ill patients. Charts of all consecutive patients who had undergone an emergency nontherapeutic laparotomy from 1996 to 2013 were retrospectively studied and patient's demographic, clinical characteristics, and surgical findings were collected. During this period 59 patients had an unnecessary laparotomy. Fifty-one patients had at least one preoperative imaging and 36 had a CT scan. CT scans were interpreted to be normal (n ¼ 12), with minor anomalies (n ¼ 10), or major anomalies (pneumoperitoneum, portal venous gas/pneumatosis intestinalis, thickened gallbladder wall, and small bowel obstruction signs). Surgical exploration was performed through laparotomy (n ¼ 55) or laparoscopy. Overall mortality was 37% with a median survival after surgery of 7 days. In univariate analysis, hospitalization in ICU before surgical exploration was the only factor related to death. In our series CT scans, objectively interpreted, helped avoid unnecessary surgical exploration in 61% of our patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%