DIAGNOSTIC LAPAROSCOPY IN THE INTENSIVE-CARE PATIENT - AVOIDING THE NONTHERAPEUTIC LAPAROTOMY

Evaluation of a potential acute abdomen in patients who require intens ive care for concurrent medical/surgical problems is often difficult d ue to ambiguities in the physical exam and ancillary diagnostic tests. Between August 1990, and February 1992, 25 ICU patients underwent dia gnostic laparoscopy to evaluate a suspected acute intraabdominal proce ss. Thirteen laparoscopies were negative, and 12 were positive. The ov erall accuracy for laparoscopy was 96% as confirmed by subsequent lapa rotomy, autopsy, or clinical course. Laparoscopic findings led to a ch ange in management in nine patients (36%), leading to earlier explorat ion in four patients, and avoidance of laparotomy in five. No signific ant hemodynamic effects were noted during laparoscopy, and the procedu re-related morbidity was low (8.0%). Diagnostic laparoscopy is a safe and accurate guide for managing the ICU patient with a suspected acute surgical abdomen. The use of laparoscopy can help avoid nontherapeuti c laparotomy or confirm the need for operative intervention in these c omplex cases.