title: How to Avoid Nontherapeutic Laparotomy in Patients With Multiple Organ Failure of Unknown Origin. The Role of CT Scan Revisited.
abstract: Diagnosis of intra-abdominal diseases in critically ill patients remains a clinical challenge. Physical examination is unreliable whereas exploratory laparotomy may aggravate patient's condition and delay further evaluation. Only a few studies have investigated the place of computed tomography (CT) on this hazardous situation. We aimed to evaluate the ability of CT to prevent unnecessary laparotomy during the management of critically ill patients. Charts of all consecutive patients who had undergone an emergency nontherapeutic laparotomy from 1996 to 2013 were retrospectively studied and patient's demographic, clinical characteristics, and surgical findings were collected. During this period 59 patients had an unnecessary laparotomy. Fifty-one patients had at least one preoperative imaging and 36 had a CT scan. CT scans were interpreted to be normal (n = 12), with minor anomalies (n = 10), or major anomalies (pneumoperitoneum, portal venous gas/pneumatosis intestinalis, thickened gallbladder wall, and small bowel obstruction signs). Surgical exploration was performed through laparotomy (n = 55) or laparoscopy. Overall mortality was 37% with a median survival after surgery of 7 days. In univariate analysis, hospitalization in ICU before surgical exploration was the only factor related to death. In our series CT scans, objectively interpreted, helped avoid unnecessary surgical exploration in 61% of our patients.
authors.affiliation: 1 Department of General, Visceral, and Endocrine Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Stephanie Li Sun
authors.initials: SL
authors.lastname: Fui
authors.forename: Renato Micelli
authors.initials: RM
authors.lastname: Lupinacci
authors.forename: Christophe
authors.initials: C
authors.lastname: Trésallet
authors.forename: Matthieu
authors.initials: M
authors.lastname: Faron
authors.forename: Gaelle
authors.initials: G
authors.lastname: Godiris-Petit
authors.forename: Harika
authors.initials: H
authors.lastname: Salepcioglu
authors.forename: Severine
authors.initials: S
authors.lastname: Noullet
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000401:mortality; D007813:Laparotomy / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: Abnormalities; CT scans; Critical care; Digestive system; Laparotomy