Fallibility of exploratory laparotomy in detection of hepatic and retroperitoneal masses

The recent wide availability of sonography and computed body tomography has added a new dimension to the diagnosis of abdominal masses. Recently in six patients exploratory laparotomy failed to reveal a mass demonstrated by preoperative cross-sectional imaging and subsequently confirmed in the postoperative period by reexamination with or without percutaneous needling. Three of the six patients had previous pancreatic inflammatory disease which may have limited the surgical evaluation of the retroperitoneum. Prior to the advent of cross-sectional imaging, there were few available direct means for discovering errors in intraabdominal surgical diagnosis. While exploratory laparotomy is obviously crucial for confirmation of abdominal masses, radiologists should be reminded that it is not infallible.