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Laparoscopy for the acute abdomen in the postoperative urologic patient
J J Bauer1, P G Schulam, H S Kaufman
1Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
Objectives:
Exploratory laparotomy offers the greatest diagnostic accuracy of intra-abdominal pathologic processes, but can be associated with significant morbidity. Laparoscopy provides diagnostic capabilities equivalent to that of open exploration, but with potentially less morbidity. We present 3 cases in which laparoscopy was used to diagnose and manage urologic patients with an acute abdomen in a postoperative period.
Methods:
Three patients underwent laparoscopy between 1 and 14 days postoperatively for an acute abdomen (fever, elevated white blood cell count, and peritoneal signs). The initial procedures included a pubovaginal sling repair with fascia lata, endoscopic placement of a percutaneous gastrostomy tube, and a laparoscopic ureterolithotomy for a distal stone.
Results:
In each of the 3 patients laparoscopy revealed misplacement or malfunction of a previously placed tube. In all cases, the patient was managed laparoscopically without the need for laparotomy.
Conclusions:
These cases demonstrate the feasibility of laparoscopy to provide diagnostic and therapeutic solutions to postoperative urologic patients presenting with an acute abdomen.