LAPAROSCOPY FOR ABDOMINAL EMERGENCIES

The role of laparoscopy has been reviewed for these conditions: abdomi nal trauma, acute abdomen, abdominal pain of uncertain etiology, appen dicitis and the acute abdomen in the intensive care unit patient. Lapa roscopy should only be performed in trauma patients who are hemodynami cally stable and who have some evidence for abdominal injury, such as a positive peritoneal lavage or a positive CT scan. Laparoscopy is an excellent procedure for determining whether a knife or missile has pen etrated the peritoneum. For penetrating wounds in the chest and upper abdomen, laparoscopy also allows excellent evaluation of the diaphragm . In blunt trauma, laparoscopy identifies the majority of injuries, bu t there has been a 5-15% incidence of missed injuries to the small bow el and colon. The acute abdomen is generally caused by perforation, ac ute inflammation or intestinal obstruction. Of the Various types of pe rforation, diagnostic and therapeutic laparoscopy is most applicable f or duodenal perforation. Acute perforation of the stomach and colon sh ould probably be treated by standard open techniques. For acute inflam matory disorders, laparoscopy is an excellent diagnostic tool and can also provide definitive treatment in the form of drainage of an absces s or appendectomy. The role of laparoscopy for ileus and bowel obstruc tion is controversial; some surgeons advocate diagnostic laparoscopy a nd treatment, while many others still consider bowel obstruction and a bdominal distention to be contraindications. Finally, there are the in tensive care unit patients in whom an acute intraabdominal process is suspected. Laparoscopy in such patients alters the clinical management in about 50% of patients. About one-half of these patients have posit ive findings which require laparotomy, while about one-half will have a negative exam and avoid a non-therapeutic Laparotomy.