AKUT KARIN VE ABDOMÝNAL TRAVMANIN TANI VE TEDAVÝSÝNDE ACÝL LAPAROSKOPÝ

Acil Laparoskopi (AL) akut karýn tanýsýnda ve abdominal travmanýn deðerlendirilmesinde yararlý bir yöntem olabilir. 15 ay içinde 20 hastaya acil laparoskopi uyguladýk. 14 hastada AL endikasyonu sað alt kadran aðrýsý (SAKA), altý hastada ise künt karýn travmasý idi. 14 hastanýn beþinde AL ile akut apandisit tanýsý kondu ve hepsine laparoskopik appendektomi yapýldý. Yapýþýklýklar nedeniyle taný konulamayan bir hastaya konvansiyonel appendektomi uygulandý. 8 hastada SAKA nedeni jinekolojikti ve bunlardan yalnýzca bir tanesine dýþ gebelik nedeniyle cerrahi giriþimde bulunuldu. 6 hastada AL endikasyonu kunt karýn travmasý idi hepsinde de ayný zamanda kafa travmasý, dördünde ise açýklanamayan hipotansiyon vardý. Hipotansiyon nedeni olarak iki hastada AL ile karýn içi kanama saptandý ve laparotomiye geçildi. Birinde dalak rüptürü, diðerinde geniþleyen bir retroperitoneal hematom mevcuttu. Yirmi hastadan yalnýz bir tanesinde AL diyagnostik olamadý. Bu hastada da eski laparatomiye ikincil karýn içi yapýþýklýklar vardý. Böylece, bu seride, AL ile %95 oranýnda doðru taný konulmuþ oldu. Serideki tek komplikasyon da taný konamayan ve konvansiyonel appendektomiye giden hastanýn trokar yerindeki yara enfeksiyonu idi. Sonuç olarak, AL sað alt kadran aðrýsýnýn ayýrýcý tanýsýna, multipl travmalý hastada tedavi önceliðinin saptanmasýna, gereksiz, laparatomilerin önlenmesine ve taný için cerrahýn baþkalarýna baðlý kalmamasýna yardým eden bir uygulama olarak deðerlendirilebilir.

EMERGENCY LAPAROSCOPY IN THE DIAGNOSIS AND TREATMENT OF ACUTE ABDOMEN AND ABDOMINAL TRAUMA

Diagnostic laparoscopy (DL) can be employed in emergency conditions either to assess the patient with abdominal trauma or in abdominal diagnostic dilemma. We performed 20 urgent of emergent DL in a period of 15 months. The indication of DL was right lower quadrant pain (RLQP) in 15 and blunt abdominal trauma in 6 patients. Appendicitis was diagnosed in five of the fourteen patients who had undergone DL for RLQP. Laparoscopic appendectomy was done in all five and conventional appendectomy (due to multiple adhesions from previous surgery) was done in one patient. In 8 patients, the origin of the RLQP was gynecological and only one patient who had tubal pregnancy needed surgical intervention. Emergent DL was performed in six patients who had. blunt abdominal trauma. All six had concomitant head injury and four of these had, in addition, unexplained hypotension. Two of these patients had blood in the abdomen and underwent laparotomy, one retroperitoneal hematoma. In one patient with RLQP laparoscopy was not diagnostic due to multiple abdominal adhesions from previous surgery. In this series DL was successful in establishing a definite diagnosis in 19/20 (95%) of the cases. Only one complication was encountered in these 20 patients and it was a wound infection at the trocar site in a patient who underwent appendectomy for a perforated appendix. In conclusion, emergency DL can diagnose dilemmas, establishes priority of treatment in the multiple injured patient and eliminates unnecessary laparatomies and expensive and time consuming laboratory examinations.