Evaluation of Laparoscopy in Undiagnosed Acute Abdomen

Naveen KK* and Aggarwal VC

Department of General Surgery, Safdarjung Hospital, India

^*Correspondance to: Naveen KK 

 PDF  Full Text DOI: 10.25107/2474-1647.2698

Abstract

Background: Nearly 35% cases of acute abdomen presenting to the emergency settings remain undiagnosed even after abdomino-pelvic CT. These cases can be managed either by active observation or exploratory laparotomy. Laparoscopy is most effective technique for bridging this gap between clinical evaluation and major surgical exploration. Undiagnosed acute abdomen is defined as acute abdomen of less than 7 days duration for which diagnosis remains uncertain after initial clinical examination and appropriate diagnostic tests. In such cases the clinical findings and radiological findings (if present) are not in synchrony to come to a conclusive diagnosis. Materials and Methods: The study was conducted in Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi over a period of 18 months. It was a non-randomized non-controlled interventional study and data was collected for each patient during pre-operative, intra-operative and post-operative period. Sixty patients presenting to the surgical emergency after fulfilling inclusion and exclusion criteria were included in the study. Patients who were undiagnosed and general condition were not improving after a period of active observation of 24 h was subjected to diagnostic laparoscopy. Follow up period was of 3 months. Results: Incidence of undiagnosed acute abdominal pain despite abdomino-pelvic CT is 13.88%. 41.66% undiagnosed acute abdomen patients had no significant findings on ultrasound. In 13.33% (n=8) patients, there were no significant findings in CT scan. The most common intraoperative finding on diagnostic laparoscopy was appendicitis (23%). Out of the 30 patients subjected to diagnostic laparoscopy, 22 patients (73.33%) were diagnosed and managed by laparoscopy only. Patients who underwent diagnostic laparoscopy had a lower readmission rate of 6.6%, 3.3% and 0% in follow up at 7 days, 1 month and 3 months with p values of 0.004, 0.002 and 0.001 respectively. Conclusion: Diagnostic laparoscopy has an important role to play in undiagnosed acute abdomen patients both diagnostically as well as therapeutically.

Keywords

Undiagnosed acute abdomen; Diagnostic laparoscopy; Management; VMMC

Cite the article

Naveen KK, Aggarwal VC. Evaluation of Laparoscopy in Undiagnosed Acute Abdomen. Clin Surg. 2020; 5: 2698.