Diagnostic Laparoscopy in Abdominal Emergencies

Abstract

Acute emergency situations often pose a diagnostic challenge to the general surgeon. The diagnosis is important due to the different pathologic conditions that might be responsible for the acute situation and therefore important for planning the correct abdominal incision or avoiding an unnecessary laparotomy. There are several noninvasive diagnostic procedures — such as ultrasonography and CT scanning — which can be performed along with plain film radiography on patients with an acute abdomen to aid the surgeon in establishing a preoperative diagnosis [1–12]. In experienced hands, which are not always available around the clock in every hospital setting, the results of these methods are quite good, but in general practice they are not completely accurate and conclusive (partly due to the patients’ physical limitations, e.g. obesity or massive bowel distension, and partly because, as already stated, they are dependent on operator skills) and they might be time-consuming and expensive (such as CT scanning) [13–15]. Another factor to keep in mind is that nowadays the mean patient age is increasing and, as a consequence, there is an increasing possibility of being confronted with emergency abdominal situations in the elderly with many co-morbidities which complicate not only the therapeutic strategy but the diagnostic approach as well.