The Usefulness of Diagnostic laparoscopy on Blunt Abdominal Trauma

Yasuaki Miki*, Junichi Sumimura, Toshimichi Hasegawa, Shin Mizutani, Osamu Monta, Yuhko Tazuke, Isamu Nagai, Kazuhiro Iwase**, Wataru Kamiike**

Department of Surgery, Kinan General Hospital
*Department of Surgery, Nanko Hospital
**First Department of Surgery, Osaka University Medical School

The usefulnes of diagnostic laparoscopy (DL) under general anesthesia was studied to determine the most appropriate treatment. Eighty-one patients with blunt abdominal trauma were hospitalized over 5 years starting in 1989. All patients underwent abdominal X-ray, and ultrasonography. Sixty-eight patients also underwent CT scanning. In addition, DL was performed in 17 patiens, because it could not be determined whether laparotomy was indicated. Further laparotomy was indicated in 13 and contraindicated in 4 patients. On DL findings, laparotomy was indicated for progressive intraperitoneal bleeding in 7 patients, slight intestinal fluid retention in 4, and slightly hemorrhagic ascites accompanied by an increased amylase level in 2. Seven of these patients were negative for Blumberg's sign. Laparotomy was contraindicated in 2 patients with peritoneal hematoma (pelvic fracture) and in 2 with abdominal wall hematoma, on DL findings. Blumberg's sign was noted in all of these patients. In addition, ascites was revealed by CT scanning in 2 of them. DL has the advantage that organ damage can be observed under direct vision and a qualitative diagnosis can be made which is unobtainable from clinical examination, X-ray, US, or CT. DL is a very useful tehcnique for determining the indications for laparotomy.

Key words
diagnostic laparoscopy, blunt abdominal trauma

Reprint requests
Yasuaki Miki Department of Surgery, Nanko Hospital
2-11-15 Kitakagaya, Suminoeku, Osaka, 599 JAPAN

Accepted
June 12, 1996

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