Page 11 - World Journal of Laparoscopic Surgery
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WJOLS
Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain
(96.9%) of these appendix specimen subsequent histology in 3 (1.7%), hepatoma in 3 (1.7%), lymphoma in 5 cases
confirmed the diagnosis of acute appendicitis. In only (2.97%). These patients were referred for expert opinion
two cases, reports of a normal appendix were obtained. and management.
The second major pathology in our study was ovarian Thus, a diagnosis (either on table or via histopatho-
cyst. Twenty-seven (16%) cases of ovarian cysts were logy) was possible in 161/168 cases (95.8%). In 7 cases
diagnosed and aspiration and/or cystectomy performed. (4.1%), there was no diagnosis after DL (appendix speci-
Subsequent histopathology of the resected cysts revealed mens were also negative). These patients continued to
benign ovarian cysts in majority of cases, i.e. 17/27 (63%), have abdominal discomfort, however, they reported
whereas a diagnosis of endometriosis was established in improvement in their symptoms post DL which may be
10/27 (37%) cases. a psychological phenomenon of ‘an intervention’ carried
Peritoneal nodules were seen in 15 (8.9%) of cases, out.
in all these cases biopsy was taken and sent for histo- The mean hospital stay in our study was 3.36 days,
pathology. All these biopsy specimens tested positive for prolonged stay of 4 days or more was seen in a few
tuberculosis (100%) and therapy was instituted. patients who had initially presented with chronic abdo-
In 38 (22.6 %) cases, no pathology could be identi- minal pain (Table 2). Majority of patients were discharged
fied and appendectomy was done [28 (73.6%) of these 38 on 1 to 3 postoperative day.
appendix specimens showed inflammatory changes on Follow-up was done at 10 days, 1 and 3 months post-
histopathology]. Combinations of pathologies were also laparoscopy. A majority of patients showed improve-
observed in 3 cases (1.8%) in which coexistence of macro- ment in their condition in both groups, especially those
scopic acute appendicitis was seen with ovarian cysts. It who had initially presented with acute abdominal pain
was possible to carry out therapeutic intervention in all (Table 4). Medical management was initiated in 7 (4.1%)
these cases. One case (0.6%) of a solitary hydatid liver cyst patients with acute and 22 (13%) patients with chronic
was seen which was missed preoperatively as patient was abdominal pain (for TB or lymphoma, etc.). A small
un-affording and advanced radiological investigation percentage of patients reported a persistence of their
were not carried out. Deroofing of the cyst was done symptoms (2.3% in the acute pain group at 10 days, none
followed by hypertonic saline wash. Drain was left in thereafter and 5.9%, 2.9% at 10 days, 1 and 3 months
situ and tremendous improvement in patient progress respectively in the chronic pain group). This does not
was witnessed later on. include the undiagnosed group. A majority of patients in
In 11 (6.5%) cases where the peroperative picture the acute group (35.1%) underwent DL within 6 to 12 hours
was unclear, biopsy/aspiration of suspicious nodules/ of presentation. However, in the chronic group, most DL
serous fluid was taken for subsequent histopatho- were carried out in the 12 to 24 hours window (35.7%).
logical/cytological/microbiological/biochemical ana-
lysis. The following diagnoses were later reached based DiSCuSSion
on results of histology and fluid cytology. Early Cirrhosis Nonspecific abdominal pain is a significant problem in
general surgery and accounts for an estimated 13 to 40%
Table 1: Age and sex distribution of patients
6,7
of emergency surgical admissions for abdominal pain.
n = 168 Number Percent
Sex Male 45 26.7 Studies have, however, doubted the effectivity of exten-
8,9
Female 123 73.2 sive investigations and several authors have document-
Age < 15 yrs 12 7.14 ed the utility of DL in the evaluation and management of
13
1630 yrs 120 71.4 such patients. 10-12 Sarfati et al in his review of 203 appen-
3145 yrs 21 12.5 dectomies concluded that adjuvant testing was not help-
> 45 yrs 15 8.92 ful and showed that outcomes were improved by early
Table 2: Presentation and clinical outcomes
Time lapse between presentation and
Mode of presentation (n = 168) surgery (n = 168) Hospital stay duration (n = 168)
Number Percent Time (hrs) Number Percent Days Number Percent
Acute 81 48.2 < 6 10 5.9 2 20 11.9
612 59 35.1 24 55 32.7
> 12 12 7.14 > 4 6 3.57
Chronic 87 51.7 < 12 17 10.1 2 11 6.5
1224 60 35.7 24 60 35.7
2432 10 5.9 > 4 16 9.52
World Journal of Laparoscopic Surgery, January-April 2015;8(1):7-12 9
