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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 |
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Published online: December 31, 1996. |
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| ABSTRACT |
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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.
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| Key words:
Diagnostic laparoscopy, Acute abdomen, Non-therapeutic laparotomy |
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