Role of laarascopy in management of acute abdomen – Copy11111 Essay

Methods :-A prospective study by following up of 60 patients of acute abdomen was done. (all of studied cases were investigated first by ultrasonography and X-ray of chest and abdomen ) .Therapeutic procedure were performed according to condition diagnosed. All patients were followed up 1 year from surgery. Results:-A total of 60 cases were analyzed . 1-48 Patients (80%) were completed successively as diagnostic and therapeutic laparoscopy. A- Appendicectomy was performed in 30 (50%) patients. B-Peptic perforations repair performed in( 9 ) PATIENTS (15%) . C-Adhesolysis 6 patients(10%) . D-Enteric perforations were (3) patients(5%) .———————————2-12patients (20%) were ended in different ways as follows—————–A-6patients (10%) were lap needed(assisted) open surgery.

3 complicated appendectomy e.g difficulties 2 and 1cecal involvement &3 complicated ovarian 2cysts gangrenous and 1hudge perforated . B-3Laparascopic surgeries converted to classical open surgery first ruptured hydatid cyst. 2nd ischemic(gangrenous)bowel 3rdruptured uterus C-3patients where classical laparotomy were avoided as followings——1st patient was diagnosed as primary peritonitis. 2nd appendicular mass who was treated by Oschner”Sheren method (conservatively) 3rd pelvic abscess who was treated by lavage and tube drainage and antibiotics without need for (opening of abdomen)or laparotomy.

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——– 5%of cases(6 pat)needed open srgery.60% of cases(36)patients were discharged within 2 days 30% discharged 3”5 days.10%dicarged (6-7)days. Conclusion:- Diagnostic laparoscopy is a golden tool in acute aids the accurate diagnosis —it eliminates un justified laparotomy. Early discharge from hospital –decreases morbidity . Key words:-Acute abdomen”Diagnostic laparoscopy ” Therapeutic laparoscopy” laparoscopic assisted open surgery-open laparotomy. Introduction :-Acute abdomen is a sudden severe abdominal pain .It is in many cases a surgical emergency requiring urgent and specific diagnosis .Several causes need surgical treatment. The main causes are acute appendicitis”acute peptic ulcer perforation “acute cholecystitis”acute pancreatitis – .Acute abdomen is occasionally used synonymously with peritonitis .While this is not entirely incorrect peritonitis is more specific term referring to inflammation of peritoneum. the most specific finding is manifest on physical examination as rebound tenderness. in emergency department and need simultaneous rapid medical(history—examination and actions)which are essential for early accurate diagnosis & treatment .The prognosis of patients depend on the experiences of medical staff received and managed them. The diagnostic laparoscopy is a new method helps surgeon to observe clearly abdominal viscera and decrease difficulties in diagnostic and therapeutic accordingly .classical (open) pain –hospital stay—increases cost”and increase morbidity 5%—25% (1).This study is aimed to assess value of laparoscopy in diagnosis and treatment of acute abdomen. Therapeutic procedures like lap appendectomy ,drainage and lavage of fluids lap assisted resection and anastomosis may be performed simultaneously. Methods :-From 1-1-2014—-31-12”2017. The first 2years were for collection of data and treatment .the last 3rd year were restricted for follow up of the results .A total of 60 patients who were admitted to the emergency department unit of Al-Hussein teaching hospital underwent diagnostic laparoscopic examinations before or instead of therapeutic laparoscopic surgeries . before operations for acute abdomen .The Patients were investigated by US of abdomen X-Ray”and CT-scan of abdomen. The variables were studied clinical feature “type of surgery—follow up observation age”gender” clinical features –type of pathology “type of surgery”operative time —- analgesia requirement”hospitalizationperiod Results :-acute abdomen is equally distributed between 2 genders male/FEMALE ratio 1:1.The age distribution showed that the most affected age group was ======== the most common condition seen was acute appendicitis (50%)of was sometimes accompanied by drainage of intraperitonial accumilates .lap. peptic perforations repair done in ——-(15%)%of cases adhes olysis 6%of cases . these surgical procedures sometimes accompanied by drainage of intraperitoneal accumilates . Enteric laparoscopic assisted open Surgeries approaches were needed. Who picile 5% converted to open CLASSICAL LAPARATOMIES were performed . in whom in lap. assisted . And enteric perforation repair done. In 5%of cases lap avoid the patient any additional surgical procedures other than diagnostic one. .Average time of lap. App was 48 minutes.——–% cases in which diagnostic lap were discharge within 2days.only few cases need stay up to they were lap. assisted open surgeries .——% of which we had performed diagnostic . lap were required only single dose analgesia.—–%of patients lap analgesia for 1day and only ——-%of patients need analgesia for 5 days in open lap. assisted surgery done.Discussion :-ACUTE ABDOMEN IS EQUALLY DISTRIBUTED among both the gender . MORE common in age group from (15—45)years. more than 90% belong to this group. pain present in all patients 96%.vomiting was the next positive symptoms .pat frequently complained of abdominal distension .Fever and constipation was also present in some cases .diarrhea was seen in few cases .abdominal tenderness is in almost all cases of acute abdomen .abdominal guardening was present and rigidity was there in most of cases .the most common condition is acute was sometimes accompanied by drainage of free fluids .laparoscopic peptic perforation repair done in ——%only —–%of cases in which lap surgeries were converted to open in whom —–%of cases —-%of cases lap assisted lower midline appendectomy and enteric perforation repair done. lap assisted resection anastomosis. now after lap diagnosis of acute appendicitis. with the same incision single incision laparoscopic appendectomy .adhesolysis was also done in considerable number of patients ,adhesolysis 2nd procedure next to ac appendicitis .adhesolysis and peptic perforation repair was also done in considerable no. of few cases no pathology was diagnosed and only drainage of fluids and lavage done .most of pat which we had perform diagnostic laparoscopy were discharge within 2days .only a few cases stay up to 6days in whom laparoscopic assisted open laparotomy es required analgesia for 5days in whom lap assisted open surgery done. average time of performing only diagnostic laparoscopy in 15 minutes and average time of performing lap. Appendectomy was 48minutes. №‰Є№і”———laparatomy.minate good tool in acute abdomen.ration repair were done in 2 patients . ———————-

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