LAPAROSCOPY FOR THE ACUTE ABDOMEN IN THE POSTOPERATIVE UROLOGIC PATIENT

Objectives. Exploratory laparotomy offers the greatest diagnostic accu racy of intra-abdominal pathologic processes, but can be associated wi th significant morbidity. Laparoscopy provides diagnostic capabilities equivalent to that of open exploration, but with potentially less mor bidity. We present 3 cases in which laparoscopy was used to diagnose a nd manage urologic patients with an acute abdomen in a postoperative p eriod. Methods. Three patients underwent laparoscopy between 1 and 14 days postoperatively for an acute abdomen (fever, elevated white blood cell count, and peritoneal signs). The initial procedures included a pubovaginal sling repair with fascia lata, endoscopic placement of a p ercutaneous gastrostomy tube, and a laparoscopic ureterolithotomy for a distal stone. Results. In each of the 3 patients laparoscopy reveale d misplacement or malfunction of a previously placed tube. In all case s, the patient was managed laparoscopically without the need for lapar otomy. Conclusions. These cases demonstrate the feasibility of laparos copy to provide diagnostic and therapeutic solutions to postoperative urologic patients presenting with an acute abdomen. (C) 1998, Elsevier Science Inc. All rights reserved.