Diagnostic laparoscopy in patients with an acute abdomen of uncertain etiology

Background: There are acute abdominal conditions in which it is difficult to establish an indicative diagnosis before laparotomy. A diagnosis is important in planning the right abdominal incision or to avoid an unnecessary laparotomy. Diagnostic noninvasive procedures such as X-ray studies do not always appear conclusive. Diagnostic laparoscopy is the only technique which can visualize the abdomen and, by establishing an adequate diagnosis, permits the surgeon to plan the right abdominal approach. Methods: In a prospective study, 65 patients with a generalized acute abdomen (no intestinal obstruction or perforation) underwent a diagnostic laparoscopy under general anesthesia previous to the planned median laparotomy. Results: In 46 patients (70%) diagnostic laparoscopy permitted the establishment of an adequate diagnosis, whereas in seven patients (10%) no cause for the acute abdomen could be found and an explorative laparotomy was avoided. In another 12 patients (20%) insufficient information was obtained during laparoscopy and an explorative laparotomy was performed. Conclusions: A conclusive diagnosis was established in 53 patients. This information led to a change in the surgical approach in 38 patients (e,g., limited, well-placed approach, laparoscopically, or avoidance of an unnecessary laparotomy). Diagnostic laparoscopy in this category of patients is a useful technique with important therapeutic consequences.