Diagnostic laparoscopy in the intensive care patient. Avoiding the nontherapeutic laparotomy.
Evaluation of a potential acute abdomen in patients who require intensive care for concurrent medical/surgical problems is often difficult due to ambiguities in the physical exam and ancillary diagnostic tests. Between August 1990, and February 1992, 25 ICU patients underwent diagnostic laparoscopy to evaluate a suspected acute intraabdominal process. Thirteen laparoscopies were negative, and 12 were positive. The overall accuracy for laparoscopy was 96% as confirmed by subsequent laparotomy, autopsy, or clinical course. Laparoscopic findings led to a change in management in nine patients (36%), leading to earlier exploration in four patients, and avoidance of laparotomy in five. No significant hemodynamic effects were noted during laparoscopy, and the procedure-related morbidity was low (8.0%). Diagnostic laparoscopy is a safe and accurate guide for managing the ICU patient with a suspected acute surgical abdomen. The use of laparoscopy can help avoid nontherapeutic laparotomy or confirm the need for operative intervention in these complex cases.
Brandt
C P
CP
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109-1998.
Priebe
P P
PP
Eckhauser
M L
ML
D000006:Abdomen, Acute / Q000175:diagnosis*; D002764:Cholecystitis / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007410:Intestinal Diseases / Q000175:diagnosis / Q000453:epidemiology; D007511:Ischemia / Q000175:diagnosis / Q000453:epidemiology; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests