DIAGNOSTIC LAPAROSCOPY IN PATIENTS WITH AN ACUTE ABDOMEN OF UNCERTAINETIOLOGY

Background: There are acute abdominal conditions in which it is diffic ult to establish an indicative diagnosis before laparotomy. A diagnosi s is important in planning the right abdominal incision or to avoid an unnecessary laparotomy. Diagnostic noninvasive procedures such as X-r ay studies do not always appear conclusive. Diagnostic laparoscopy is the only technique which can visualize the abdomen and, by establishin g an adequate diagnosis, permits the surgeon to plan the right abdomin al approach. Methods: In a prospective study, 65 patients with a gener alized acute abdomen (no intestinal obstruction or perforation) underw ent a diagnostic laparoscopy under general anesthesia previous to the planned median laparotomy. Results: In 46 patients (70%) diagnostic la paroscopy permitted the establishment of an adequate diagnosis, wherea s in seven patients (10%) no cause for the acute abdomen could be foun d and an explorative laparotomy was avoided. In another 12 patients (2 0%) insufficient information was obtained during laparoscopy and an ex plorative laparotomy was performed. Conclusions: A conclusive diagnosi s was established in 53 patients. This information led to a change in the surgical approach in 38 patients (e,g., limited, well-placed appro ach, laparoscopically, or avoidance of an unnecessary laparotomy). Dia gnostic laparoscopy in this category of patients is a useful technique with important therapeutic consequences.