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J Korean Soc Emerg Med > Volume 7(4); 1996 > Article
Journal of The Korean Society of Emergency Medicine 1996;7(4): 545-553.
DIAGNOSTIC LAPAROSCOPY IN PATIENTS WITH AN ACUTE ABDOMINAL PROBLEM
Joong Eui Rhee1, Ho Suk Lee2, Yeo Kyu Youn1
1Department of Emergency Medicine, Seoul National University Hospital
2Department of Surgery, Public Corporation Inchon Medical Center
  Published online: December 31, 1996.
ABSTRACT
From October 1994 to March 1996, 45 diagnostic laparoscopies (DLs) were performed in a middle class hospital. 40 patients had the impression of acute appendicitis as 1st or 2nd choice, 2 were patients of trauma due to fall-down and car crash, 1 chronic liver disease with acute epigastric pain, 1 peritonitis symtoms, and 1 chronic right lower quardrant pain. Sex ratio of the patients was 2:3 and mean age 27.8. The DL diagnoses were 29 acute appendicitis, 3 mesenteric lymphadenitis, 3 pelvic inflammatory diseases, 1 tuberculous lymphadenitis, 1 hepatocellular carcinoma, 1 Graafian follicular rupture, 1 endometriosis, 1 ovarian cyst torsion, 1 hydrosalpinx, and 2 (4.4%) no specific findings. First impressions were not correct in 18ases(41.9%, trauma cases excluded). Abdominal ultrasonographies (USGs) were performed in 13 cases, and diagnostic in only 5 cases (38.4%). Positive finding of USG was diagnostically helpful, but negative finding was useless. 4 cases (including 2 trauma cases) were checked with abdominal CT and all were diagnostic, but in trauma cases, CT was not thought to be helpful to decision-making about laparotomy. According to laparoscopic findings, 2 trauma patients were treated conservatively, and non-therapeutic laparotomies avoided. Epidural anesthesia was tried in 2 cases and local anesthesia in 2 trauma cases. It took about 30 minutes to perform DL. There were only 5 trivial complications of 3 urinary retensions, 1 subcutaneous emphysema and 1 stitch abscess. Conclusively, DL were more diagnostic in emergency evaluation of acute abdomen than USG and more helpful to decision-making of abdominal trauma than CT. DL was thought to be a minimally invasive, safe, accurate, and sometimes therapeutical diagnostic method for acute abdominal problem, especially in young female and abdominal trauma patients. It is suggested that DL can be a useful adjunct to the emergency physician's armamentarium, and that the use of DL is adopted to the training course of the emergency medicine to help attain a diagnosis in patients presenting with acute abdomen or abdominal trauma.
Key words: Diagnostic laparoscopy, Acute abdomen, Non-therapeutic laparotomy
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