Clinical Evaluation of Laparoscopic diagnosis for Injuries of the Gastrointestinal Tract

Takao Nakagawa, Tadashi Suzuki, Masatake Ishikawa, Kiyotaka Nakajima, Yutaka Sonoda, Toshimitsu Yokoyama, Yoshiaki Horie, Kiyokata Miyazaki, Kyoichi Hamano

Department of Emergency Medicine, Department of Surgery II, Tokyo Women's Medical College

In managing abdominal trauma, newer noninvasive imaging techniques such as ultrasonography and CT usually make an accurate diagnosis possible as far as injuries to paranchymatous organs are concerned. However, in diagnosing injuries to luminal organs, nothing decisive is yet available, except of intraabdominal free air radiological observation. In the last 7 years and 4 months, 380 cases of abdominal trauma were experienced at our institution. The ultrafine laparoscope with a 3.4-mm or 2.0-mm external diameter was used in 22 of these cases where injuries to luminal organs were suspected and indication for surgery was at issue. Intraabdominal organ injuries were demonstrated in 21 cases and in 12 cases (57.1%), direct observation of the injured site was possible. Laparoscopic findings were decisively indicative for an emergency operation in 5 cases (22.7%); i.e., 3 cases of gastrointestinal tract rupture and 2 cases of progressive intraabdominal bleeding. The other 17 patients with minor laparoscopic findings improved with conservative therapy, and it can be said that proper determination of the indication for an emergency operation was made in all 22 cases. Three patients with iatrogenic injury were included, and all of them were spared unnecessary laparotomy. From the above, it may be concluded that in managing abdominal trauma where the indication for surgery is difficult to assess, laparoscopy is a quite useful diagnostic aid.

Key words
emergency laparoscopy, ultrafine laparoscope, abdominal trauma, gastrointestinal tract injury, iatrogenic intraabdominal injury

Reprint requests
Takao Nakagawa Department of Emergency Medicine, Department of Surgery II, Tokyo Women's Medical College
8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
October 11, 1990

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