[Value of celioscopy in the diagnosis of abdominal wounds]

Gunshot or stab wounds with equivocal evidence of intraabdominal injury lead to negative laparotomy in 20% to 30% of cases. The aim of this prospective study was to evaluate, in hemodynamically stable patients, the role of laparoscopy in order to reduce the rate of unnecessary laparotomies for such wounds. This study was carried out in 21 patients. Laparoscopy revealed 15 penetrating wounds (71.4%) with two isolated diaphragmatic injuries. Eight laparotomies (38%) for visceral injuries were performed on the 15 penetrating wounds. The laparoscopic exploration was complete in 7 cases without laparotomy. Thirteen unnecessary laparotomies were avoided (62%). Laparoscopy was found to have a 100% specificity and sensitivity for the diagnosis of peritoneal effraction and diaphragmatic injury. Laparoscopy is very effective for evaluation of equivocal penetrating wounds.