Surgical Endoscopy

, Volume 7, Issue 3, pp 168–172 | Cite as

Diagnostic laparoscopy in the intensive care patient

Avoiding the nontherapeutic laparotomy
  • Christopher P. Brandt
  • Paul P. Priebe
  • Marc L. Eckhauser
Original Articles


Evaluation of a potential acute abdomen in patients who require intensive care for concurrent medical/surgical problems is often difficult due to ambiguities in the physical exam and ancillary diagnostic tests. Between August 1990, and February 1992, 25 ICU patients underwent diagnostic laparoscopy to evaluate a suspected acute intraabdominal process. Thirteen laparoscopies were negative, and 12 were positive. The overall accuracy for laparoscopy was 96% as confirmed by subsequent laparotomy, autopsy, or clinical course. Laparoscopic findings led to a change in management in nine patients (36%), leading to earlier exploration in four patients, and avoidance of laparotomy in five. No significant hemodynamic effects were noted during laparoscopy, and the procedure-related morbidity was low (8.0%).

Diagnostic laparoscopy is a safe and accurate guide for managing the ICU patient with a suspected acute surgical abdomen. The use of laparoscopy can help avoid nontherapeutic laparotomy or confirm the need for operative intervention in these complex cases.

Key words

Acute abdomen ICU Diagnostic laparoscopy 


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  1. 1.
    Bailey R, Laws H (1990) Diagnostic peritoneal lavage in evaluation of acute abdominal disease. South Med J 23: 422–424Google Scholar
  2. 2.
    Berci G, Sackier J, Paz-Partlow M (1991) Emergency laparoscopy. Am J Surg 161: 332–335Google Scholar
  3. 3.
    Borzotta A, Polk H Jr (1982) Multiple systems organ failure. Surg Clin North Am 63: 315–336Google Scholar
  4. 4.
    Cornwell III E, Rodriguez A, Mirvis S, Shorr R (1989) Acute acalculous cholecystitis in critically injured patients. Ann Surg 210: 52–55Google Scholar
  5. 5.
    Ferraris V (1983) Exploratory laparotomy for potential abdominal sepsis in patients with multiple-organ failure. Arch Surg 118: 1130–1133Google Scholar
  6. 6.
    Glenn J, Funkhowser W, Schneider P (1989) Acute illnesses necessitating urgent abdominal surgery in neutropenic cancer patients: Description of 14 cases and review of the literature. Surgery 105: 778–789Google Scholar
  7. 7.
    Hayward R, Calhoun T, Korompai F (1979) Gastrointestinal complications of vascular surgery. Surg Clin North Am 59: 885–903Google Scholar
  8. 8.
    Hinsdale J, Jaffe B (1984) Re-operation for intra-abdominal sepsis. Ann Surg 199: 31–36Google Scholar
  9. 9.
    Hoffman J, Lanng C, Shoksuh-Amiri M (1988) Peritoneal lavage in the diagnosis of acute peritonitis. Am J Surg 155: 359–360Google Scholar
  10. 10.
    Iberti T, Salky B, Onofrey D (1989) Use of bedside laparoscopy to identify intestinal ischemia in postoperative cases of aortic reconstruction. Surgery 105: 686–689Google Scholar
  11. 11.
    Indeck M, Peterson S, Smith J, Brotman S (1988) Risk, cost and benefit of transporting ICU patients for special studies. J Trauma 28: 1020–1025Google Scholar
  12. 12.
    Nagy A, Jamos D (1989) Diagnostic laparoscopy. Am J Surg 157: 490–493Google Scholar
  13. 13.
    Nathanson L, Easter D, Cuschieri A (1990) Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer. Surg Endosc 4: 232–233Google Scholar
  14. 14.
    Norwood S, Civetta J (1985) Abdominal CT scanning in critically ill surgical patients. Ann Surg 202: 166–175Google Scholar
  15. 15.
    Richardson J, Flint L, Polk H Jr (1983) Peritoneal lavage: a useful diagnostic adjunct for peritonitis. Surgery 94: 826–829Google Scholar
  16. 16.
    Rosemurgy A, McAllister E, Karl R (1988) The acute surgical adomen after cardiac surgery involving extra-corporeal circulation. Ann Surg 207: 323–326Google Scholar
  17. 17.
    Savino J, Scalea T, Del Guerico L (1985) Factors encouraging laparotomy in acalculous cholecystitis. Crit Care Med 13: 377–380Google Scholar
  18. 18.
    Sinanan M, Maier R, Carrico J (1984) Laparotomy for intra-abdominal sepsis in patients in an intensive care unit. Arch Surg 119: 652–658Google Scholar
  19. 19.
    Tibbs P, Bivins B, Young A (1979) The problems of acute abdominal disease during spinal shock. Am Surg 45: 366–368Google Scholar
  20. 20.
    Wallwork J, Davidon K (1980) The acute abdomen following cardiopulmonary bypass surgery. Br J Surg 67: 410–412Google Scholar
  21. 21.
    Whitley N, Shatney C (1982) Diagnosis of abdominal abscesses in patients with major trauma: the use of computed tomography. Radiology 147: 179–183Google Scholar

Copyright information

© Springer-Verlag New York Inc 1993

Authors and Affiliations

  • Christopher P. Brandt
    • 1
  • Paul P. Priebe
    • 1
  • Marc L. Eckhauser
    • 1
  1. 1.Department of Surgery, MetroHealth Medical CenterCase Western Reserve UniversityClevelandUSA

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