Laparoscopy in the critically ill.
BACKGROUND
Laparoscopy was evaluated in critically ill patients with suspected acute cholecystitis, mesenteric ischemia, or gastrointestinal perforation. We studied laparoscopy to assess its utility, accuracy, and effect on cardiopulmonary stability.


METHODS
Twenty-six surgical ICU patients with possible abdominal sepsis underwent laparoscopy. Nineteen were post cardiac surgery; the remainder had other diagnoses. Video laparoscopy was performed with hemodynamic monitoring and inotropic support as needed. Eight patients had bedside laparoscopy.


RESULTS
Fifteen patients had suspected acute cholecystitis. Laparoscopy was positive in 10; four had open cholecystectomy, four laparoscopic cholecystectomy, and two tube cholecystostomy. Nine patients had suspected mesenteric ischemia; laparoscopy was positive in five, revealing cirrhosis in two and ischemic bowel in three. Two patients had suspected perforated viscus with colonic perforation in one and one false negative. There were no adverse hemodynamic events.


CONCLUSIONS
Laparoscopy can be performed safely in critically ill patients. It is useful in patients with acute cholecystitis and in patients who are post cardiac surgery with refractory lactic acidosis in whom a diagnosis of mesenteric ischemia is considered.
Orlando
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Department of Surgery, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102-5037, USA, and University of Connecticut School of Medicine, Farmington, CT 06034, USA.
Crowell
K L
KL
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000175:diagnosis*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D010535:Laparoscopy; D008297:Male; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D012189:Retrospective Studies; D013525:Surgical Instruments