Role of Diagnostic Laparoscopy in Abdominal Trauma

Abstract

Abdominal trauma affects 10% to 15% of injured patients. Although significant intra-abdominal injury is relatively infrequent, the consequences of missed or delayed diagnosis can be significant. Therefore, accurate and timely diagnosis of injuries is essential. The initial history and physical examination are of paramount importance information regarding the mechanism of injury and state of the patient before arriving in the emergency department. Mechanisms of injuries may be penetrating or blunt. The most common cause of mortality in abdominal trauma is secondary to delayed resuscitation or excessive hemorrhage with inadequate volume resuscitation or Intra-abdominal organ injury and rupture or perforation precipitates gastrointestinal content spillage into the peritoneal cavity, frequently leading to peritonitis and delayed mortality from severe sepsis. Despite the high prevalence of patients with abdominal trauma. Physical examination not be accurate because patients may have altered mental status or distracting injuries. Diagnostic peritoneal lavage was introduced as a diagnostic modality to identify hemoperitoneum but it is invasive method and its role has been almost entirely eliminated because there has been increased reliance on abdominal computed tomography. Focused Assessment with Sonography in trauma and has also been added to the diagnostic algorithm for patients with abdominal trauma. In hemodynamically stable victims of blunt trauma, Computed Tomography (CT) with intravenous contrast has become the gold standard for the diagnostic evaluation of the abdomen, with greater than 95% specificity for detecting injury to the solid organs (liver, spleen, and kidney). Injury to the intestine, pancreas, mesentery, and diaphragm are more difficult to diagnose with CT. Even in the current era of multidetector scanners, up to 21% of patients with bowel or mesenteric injuries may initially have negative studies. In hemodynamically unstable victims, diagnostic laparoscopy has proven to be a useful modality in these situations. The burden of major trauma, predominantly blunt in nature, continues to rise in the most of the countries. More often the young are affected with lifelong debilitating consequences. Minimally invasive technique, such as laparoscope procedures, have become standard for the treatment of many surgical conditions, being able to minimize the impact of the surgery, to reduce postoperative pain, time to recover and to improve cosmetic outcomes In laparoscopic the relative morbidity and mortality, complication rates, and missed injury rates are low and comparable with open approaches. Additionally, a wide variety of intra-abdominal pathology can be addressed laparoscopically including injuries to the bowel, diaphragm, liver, spleen, and pancreas. The recent guidelines developed by the Eastern Association for the Surgery of Trauma Practice Management Guidelines Committee recommend selective non-operative management in penetrating abdominal trauma and that routine laparotomy is not indicated in hemodynamically stable patients with abdominal stab wounds without signs of peritonitis or diffuse abdominal pain and in patients suffering tangential gunshot wounds without peritonitis. Our study was randomized prospective study. It include 50 patients with abdominal trauma of any type whether blunt or penetrating, RTA or falling from height, stab or gunshot. In order to study the sensitivity and specificity in diagnosis and evaluation of abdominal trauma by the use of ultrasonography, CT and abdominal laparoscopy and comparing accuracy of diagnosis of them with the final diagnosis.