LAPAROSCOPY IN THE CRITICALLY ILL

Background: Laparoscopy was evaluated in critically ill patients with suspected acute cholecystitis. mesenteric ischemia, or gastrointestina l 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, Ni neteen were post cardiac surgery; the remainder had other diagnoses, V ideo laparoscopy was performed with hemodynamic monitoring and inotrop ic support as needed. Eight patients had bedside laparoscopy. Results: Fifteen patients had suspected acute cholecystitis. Laparoscopy was p ositive in 10; four had open cholecystectomy, four laparoscopic cholec ystectomy, and two tube cholecystostomy. Nine patients had suspected m esenteric ischemia; laparoscopy was positive in five, revealing cirrho sis in two and ischemic bowel in three, Two patients had suspected per forated viscus with colonic perforation in one and one false negative. There were no adverse hemodynamic events. Conclusions: Laparoscopy ca n be performed safely in critically ill patients. It is useful in pati ents with acute cholecystitis and in patients who are post cardiac sur gery with refractory lactic acidosis in whom a diagnosis of mesenteric ischemia is considered.