20Jan 2017

LAPAROSCOPY ROLE IN DIAGNOSIS AND MANAGEMENT OF UNEXPLAINED/NONSPECIFIC ABDOMINAL PAIN.

  • Medical Intern, College of Medicine, King Saud University, Riyadh, Saudi Arabia. College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Background:unexplained/nonspecific abdominal pain makes up a high percentage of surgical admissions to hospitals, both in emergency department, and as elective admissions,with a substantial diagnostic dilemma. Objective: The aim of this study was to determine if laparoscopy has any significant role in the diagnosis and management of unexplained/nonspecific abdominal pain. PatientsandMethods: All patients who presented to the hospital with abdominal pain with no identifiable etiology and after clinical examination, assessment and investigations were labeled as unexplained/nonspecific abdominal pain, and after that underwent diagnostic laparoscopyto reach a definitive diagnosis were included in the study. Results:127 patients were included in the study. Females accounted for 67% (n=85) and males33% (n=42). The mean age was 28 years (ranged from18-58 years).Out-patient department was the commonest mode of admission,99 (78.4%) patients. Patients who presented with unexplained/nonspecific abdominal pain in the lower part of abdomen accounted for 29% (n=37), followed by 25% (n=32) with right lower abdominal pain, and 22% (n=28) with periumbilical pain radiating to right lower abdomen. Diagnosis was established in 85%(n=108) of patients. In 15% (n=19) no pathology was found. The most common diagnosis was pathology of appendix in 33% (n=42) of patients followed by pelvic pathology in 20% (n=25), and abdominal tuberculosis in 16% (n=20) of patients. Most of the patients (42%, n=53) stayed in the hospital for 24 h. There were no major postoperative complications and no readmissions. Conclusion: Laparoscopy has a definitive role in the diagnostic dilemma associated with unexplained/nonspecific abdominal pain. It has at the same time a role in treatment, decreasing mortality, morbidity, cost, hospital stay, and improving quality of life relative to observation; hencelaparoscopy is an effective diagnostic and therapeutic modality in the management of patients with unexplained/nonspecific abdominal pain.

  1. Sheridan WG, White AT, Havard T, Crosby DL. Non-specific abdominal pain: The resource implications. Ann R CollSurgEngl 1992; 74:181-5.
  2. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am 2003; 21:61-72, vi.
  3. Heafield R, Roe AM, Watkins R, Brodribb AJ, Brown C. Outcome of emergency surgical admissions for non-specific abdominal pain. Gut 1990;31: A1167.
  4. El-Labban GM, Hokkam EN. The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain. J Minim Access Surg 2010; 6:95-9.
  5. Peters AA, Van den Tillaart SA. The difficult patient in gastroenterology: Chronic pelvic pain, adhesions, and sub occlusive episodes. Best Pract Res ClinGastroenterol. 2007; 21:445–63.
  6.  Van Goor H. Consequences and complications of peritoneal adhesions. Colorectal Dis. 2007; 9:25–34.
  7. Dumont RC, Caniano DA. Hypokinetic gallbladder disease: A cause of chronic abdominal pain in children and adolescents. J PediatrSurg. 1999; 34:858–61.
  8. Johnson CD. ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder. BMJ. 2001; 323:1170–3.
  9. Fayez JA, Toy NJ, Flanagan TM. The appendix as the cause of chronic lower abdominal pain. Am J ObstetGynecol. 1995; 172:122–3.
  10. Mertz HR. Irritable bowel syndrome. N Engl J Med. 2003; 349:2136–46.
  11. Tack J, Lee KJ. Pathophysiology and treatment of functional dyspepsia. J ClinGastroenterol. 2005;39: S211–6.
  12. Galili O, Shaoul R, Mogilner J. Treatment of Chronic Recurrent Abdominal Pain: Laparoscopy or Hypnosis?J LaparoendoscAdvSurg Tech A. 2009; 19:93–6.
  13. Cuesta MA, Borgstein PJ, Meijer S. Laparoscopy in the diagnosis and treatment of acute abdominal conditions. Clinical review. Eur J Surg 1993; 159:455-6.
  14. nders RP, Mittendorf EA. Utility of laparoscopy in chronic abdominal pain. Surgery 2003; 134:549-52.
  15. Domínguez LC, Sanabria A, Vega V, Osorio C. Early laparoscopy for the evaluation of nonspecific abdominal pain: A critical appraisal of the evidence. SurgEndosc 2011; 25:10-8.
  16. Kapshitar' AV. The indications for performing diagnostic and therapeutic laparoscopy in emergency surgery on the abdominal organs. KlinKhir 1998;12-4.
  17. Aslam MN, Ehsan O, Ali AA, Gondal KM, Choudhry AM. Diagnostic laparoscopic surgery: A good surgical tool. Pak J Surg 2001; 17:31-4.
  18. Lippert V, Zaage J, Pilz F. Diagnostic laparoscopy and laparoscopic appendectomy in the diagnosis and therapy concept of abdominal pain of unknown origin. ZentralblChir 1998;123 Suppl 4:46-9.
  19. Ou CS, Rowbotham R. Laparoscopic diagnosis and treatment of nontraumatic acute abdominal pain in women. J LaparoendoscAdvSurg Tech A 2000; 10:41-5.
  20. Al-Bareeq R, Dayna KB. Diagnostic laparoscopy in acute abdominal pain: 5-year retrospective series. Bahrain Med Bull 2007; 29:1-5.
  21. McCartan DP, Fleming FJ, Grace PA. The management of right iliac fossa pain-is timing everything? Surgeon 2010; 8:211-7.
  22. Hossain J, al-Aska AK, al Mofleh I. Laparoscopy in tuberculous peritonitis. J R Soc Med 1992; 85:89-91.
  23. Salky BA, Edye MB. The role of laparoscopy in the diagnosis and treatment of abdominal pain syndromes. SurgEndosc 1998; 12:911-4.
  24. Gaitán H, Angel E, Sánchez J, Gómez I, Sánchez L, Agudelo C. Laparoscopic diagnosis of acute lower abdominal pain in women of reproductive age. Int J GynaecolObstet 2002; 76:149-58.
  25. Poulin EC, Schlachta CM, Mamazza J. Early laparoscopy to help diagnose acute non-specific abdominal pain. Lancet 2000; 355:861-3.

[Faisal Abdullah Al Qahtani, Hamad Mohammed Al Selaimy and Saad Mohammed Al Muqrin. (2017); LAPAROSCOPY ROLE IN DIAGNOSIS AND MANAGEMENT OF UNEXPLAINED/NONSPECIFIC ABDOMINAL PAIN. Int. J. of Adv. Res. 5 (Jan). 205-209] (ISSN 2320-5407). www.journalijar.com

Hamad Mohammed Al Selaimy
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

DOI:

Article DOI: 10.21474/IJAR01/2739      
DOI URL: http://dx.doi.org/10.21474/IJAR01/2739

Download Full Paper

Download PDF No. of Downloads: 29 | No. of Views: 136