Diagnostic laparoscopy in acute abdominal pain

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.

Laparoscopy in management of surgical causes of acute verses chronic pain abdomen in adults visiting tertiary care hospital in Telangana, India

“…Laproscopy conversion rate was 0.6% and 0.6% in patients with AAP and CAP in this study and 0 (0%) in study by Rathod et al (shown in Table 6). 19 This study shows more patients with chronic pain abdomen underwent laparoscopy compared with AAP, which was not statistically significant. Though the mean duration of post-operative complications and postoperative symptomatic relief was more in patients with CAP compared with AAP, it was not statistically significant.…”

“…Rao et al study 18. Also appendicitis was 32% which was very high in study by Thawait et al and Subramaniam et al 79% diverticulitis was 0.6% in current study which was very low, compared with study by Bahram et al it was 5% (shown in Table6) 16,17,19. Causes of chronic abdomen in current study was chronic appendicitis (23/13.7%) which was low compared with study by Brahman et al (23.75%) and Schrenk et al (32.25%) 17,20.…”

Role of Laparoscopy in Management of Doubt Cases of Acute Abdomen

“…Subramaniam [1] reported acute appendicitis as the most common cause of acute abdomen [79.0%; high percentage than the current work], followed by perforated peritonitis [9.0% [7% duodenal & 2% ileal]].…”

“…So diagnostic accuracy of radiological investigations was 60.0% [18 out of 30 cases] while the same for laparoscopy was 90.0% [27 out of 30 cases]. Subramaniam [1] reported that, laparoscopy was able to diagnose 7.0% over the radiological work up in acute abdomen [e.g., mesenteric ischemia, ectopic pregnancy, twisted ovarian cyst and ileal perforation].…”

“…In this era of increasing medical litigation, the surgeon has to be very careful about his patient. It is mandatory to come to a correct diagnosis and to treat accordingly [1] .…”