الفهرس 
Pathophysiology of Acute AbdomenOnly 14 pages are availabe for public view
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Abstract
Laparoscopy has many applications in acute abdomen, due to diverse etiologies of acute abdomen including those that can be managed medically. It has a great value in diagnosis of etiology of acute abdomen, in differentiation between the causes that need exploration and the causes that need medical treatment, especially in cases that we will wait and see or investigate and see. It is used after other investigation modalities as ultrasound or CT.
It’s used in treatment of acute appendicitis, acute cholecystitis, empyema of gall bladder, mucocele of gall bladder, removal of intestinal adhesions in intestinal obstruction, in acute diverticulitis, and in removal of the segment of intestine affected by Crohn’s disease presented by intestinal obstruction. It can be used in intestinal ischemia to diagnose it with certain precautions and to resect the gangrenous segment if presented in addition to removal of Meckel’s diverticulum.
To use laparoscopy for therapeutic purposes in acute abdomen, it’s preferred for patients having localized infection which didn’t reach the diffuse peritonitis stage. Other relative contraindications are very obese patients who have much intraperitoneal fat that makes dissection difficult or delayed cases after 48 of the onset of acute abdomen that may have a phlegmon obscuring the field and pregnant females according to surgeon’s talent and experience. Coagulopathy is an absolute contraindication for laparoscopy.
In patients with acute abdomen due to splenic pathology it can be used to remove the spleen provided that the patient is hemodynamicaly stable and the bleeding is not so massive to obscure the field.
The first step of laparoscopic surgery is induction of pneumoperitoneum followed by insertion of laparoscopic instruments which consist of laparoscope which is connected to light source and video signal processor which connect it to monitor. To introduce the laparoscope to the abdominal cavity various techniques and trocares are used including Veress needle and Hasson trocar technique. Other instruments of laparoscopic surgery include graspers and staplers. Sutures are taken intra or extra-corporeal.
It has many advantages when used in acute abdominal surgery such as reduction of wound size thus giving better cosmetic results of the wound , less post operative pain and thus less hospital time stay, early return of bowel function, early return to work and less post operative adhesions with less incidence of post operative intestinal obstruction.
The main disadvantage of laparoscopic surgery is relatively longer operative time, higher economic cost and its need to expertised surgeon. There is a higher incidence of vascular injury.
Laparoscopy has its own complications as:
1- Reduction of cardiac output and lung compliance which obligate us to use it advertently in cardiac and pulmonary patients,
2- Pulmonary embolism,
3- Rectus sheath hematoma,
4- Higher incidence of vascular injury,
5- Iatrogenic perforation of a viscus which may go unnoticed.
As mentioned before it must be used with specific precautions in cardiac and pulmonary patients although it has a value in reduction of post operative incidence of atelectasis and pneumonia in pulmonary patients. Portal hypertension patients and pregnant females are other examples of cases in which laparoscopy must be used with precaution.
In ICU patients laparoscopy has a great advantage in diagnosis of their etiology of acute abdomen noticing that it can be used under local anesthesia thus reducing the incidence of negative laparotomies and the hazards brought from their transmission to radiology units, it has its advantages in patients who have HIV infection.