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.
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109-1998.
C P
CP
Brandt
P P
PP
Priebe
M L
ML
Eckhauser
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