Bedside laparoscopy in the ICU: Report of four cases

Background: Patients in the intensive care unit (ICU) may suffer from life- threatening abdominal pathologies, which may necessitate a surgical interve ntion. Diagnosis may be difficult, as deep sedation and analgesia often mas k symptoms, and physical examination is unreliable. Imaging studies are not accurate enough, and exploratory laparotomy carries significant morbidity and mortality rates in this patient population. The unstable patient is dif ficult to mobilize to the imaging department or to the operating room. Beds ide laparoscopy may overcome these difficulties. Patients and Methods: We describe our initial experience with the use of be dside laparoscopy in critical patients with suspected abdominal pathology. The procedure was performed in four patients over a 4-month period and comp leted in all four. Results: The findings were: turbid fluid consistent with viscus perforation in a patient with unexplained sepsis after cardiac surgery, sterile hemorr hagic fluid in a patient with malignancy and thrombotic thrombocytopenia pu rpura, a retroperitoneal mass from which biopsies were taken in a patient w ith sudden respiratory failure, and abdominal abscess in a patient after bo wel resection for mesenteric embolism. None of these patients had a laparot omy after the laparoscopy. Patients 1 and 4 died a few hours after the proc edure from sepsis, and patients 2 and 3 died several days later. Conclusion: Bedside laparoscopy in the ICU is feasible, informative, and ac curate. It has a role in diagnosing abdominal pathologies and planning furt her treatment. It may avert a nontherapeutic laparotomy. Unfortunately, the prognosis in these patients is poor. Earlier use of this diagnostic modali ty may improve patient outcome.