DIAGNOSTIC LAPAROSCOPY IN PATIENTS WITH ACUTE-LEUKEMIA AND SUSPECTED HEPATIC CANDIDIASIS

To assess the value of laparoscopy in the diagnosis of suspected hepat osplenic candidiasis in patients with acute leukemia, a retrospective analysis of 28 laparoscopies was conducted. In all but two cases, imag ing of the liver showed focal lesions before laparoscopy. Diagnosis of hepatic candidiasis was established significantly more often when the biopsy was targeted at white nodules (in 12 of 22 laparoscopies) than when targeted randomly or at scars (0 of 6 laparoscopies) (p = 0.017, chi-square test). Yeast was detected more often if the laparoscopy wa s performed during the three-week period after recovery from neutropen ia (in 8 of 12 laparoscopies) than when performed later (in 4 of 16 la paroscopies) (p = 0.028, chi-square test), In addition to the 12 lapar oscopically diagnosed patients, eight (29%) patients were diagnosed wi th disseminated Candida infection by other methods. In another eight ( 29%) patients the causative agent was not identified. No bleeding or o ther problems occurred after the laparoscopy. Laparoscopy-guided liver biopsy is most useful if biopsies are targeted to macroscopic lesions and if laparoscopy is performed soon after recovery from neutropenia.