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Diagnostic Lap in NCPA
carcinoma of gall bladder, 1 open cholecystectomy for sealed Table 4 shows sensitivity, specificity, and accuracy along
gall bladder perforation. One Whipple’s procedure for bulky head with p value significance level of laparoscopic findings which
of pancreas histopathology (HPE) revealed as granulomatous was compared with final diagnosis in diagnosing of NCPA,
pancreatitis (Fig. 3), and one open adrenal lipoma excision. There sensitivity—98.2%, specificity—100.0%, and accuracy—98.4%,
are no postprocedure complications in all 62 cases. p-value is <0.001 (p-value significance level is <0.05).
Table 3 shows sensitivity, specificity, and accuracy along with Table 5 shows radiological findings sensitivity, specificity
p value significance level of radiological investigations, which and accuracy along with p value significance level which was
was compared with final diagnosis for diagnosing of NCPA. compared with laparoscopic findings for diagnosing of NCPA,
Sensitivity—16.4%, specificity—57.1%, and accuracy—21.0%, sensitivity—16.7%, specificity—62.5%, and accuracy—22.6%,
p-value is 0.125 (p-value significance level is <0.05). p-value is 0.177 (p-value significance level is <0.05).
Effect of Diagnostic Laparoscopy on Diagnosis
In this study of 62 cases, in 45 (72.58%) cases, the final diagnosis was
same as that of diagnostic laparoscopy, in 6 (9.6%) cases, the final
diagnosis was made after HPE, in 7 cases, the diagnostic laparoscopy
(DL) failed to diagnose the cause (normal findings), and in 4 cases,
the final and laparoscopic diagnosis were both different (Table 6).

dIscussIon
NCPA is a frequent problem, dealt with by different medical
specialists. Even after an extensive workup in some patients,
no specific cause or pathological condition is found by use of
noninvasive investigation, and the pain is often attributed to
unsubstantiated diagnosis. Despite of advanced diagnostic
machinery with sophisticated methodology to image abdominal
contents, establishment of a diagnosis prior to surgery remains
difficult for several conditions. Unnecessary or negative laparotomy
is painful, increases hospital stay, increases hospital cost, and is
Fig. 2: Intestinal mucormycosis specimen
associated with a morbidity of 5 to 20%.
Overall in 62 patients, radiological imaging modality gave
probable diagnosis in 28 (45.16%) patients, normal study in 10
(16.12%) patients, and in remaining 24 (38.70%) patients, diagnosis
was inconclusive. Subsequent DL and HPE reveled that out of
these 24 cases, 15 (62.5%) patients are having appendicitis. Based
on USG findings, 11 patients were diagnosed as having ileocecal
thickening (Fig. 4) and mesenteric lymphadenopathy with
tuberculosis (TB) as first differential diagnosis. However, CECT
confirmed ileocecal tuberculosis in six cases only. All of them have
undergone colonoscopy and biopsy. Colonoscopy biopsy failed
to prove tuberculosis in any one of them. Only one of these six
cases was finally diagnosed as having ileocecal tuberculosis on
HPE following resection of affected segments. Therefore recurrent
vague pain in lower abdomen with nonspecific radiological finding
may be consistent feature of recurrent or chronic appendicitis and
DL seems to be more useful.
14
In a similar study on 88 patients by Ahmad et al., 38
(43.10%) patients’ abdominal ultrasound was normal. The
Fig. 3: Whipple’s procedure specimen—granulomatous pancreatitis most common finding noted on USG abdomen and pelvis was

Table 3: Radiological findings compared with final diagnosis
Final diagnosis
Positive Negative
Radiological findings Frequency Percentage (%) Frequency Percentage (%) p value
Positive 9 16.4 3 42.9
Negative 46 83.6 4 57.1 0.125
Total 55 100 7 100
Sensitivity Specificity PPV NPV Accuracy
16.4% 57.1% 75.0% 8.0% 21.0%

World Journal of Laparoscopic Surgery, Volume 14 Issue 2 (May–August 2021) 83