الفهرس 
Diagnosis of Acute AbdomenOnly 14 pages are availabe for public view
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Abstract
The term acute abdomen refers to abdominal pain that begins suddenly and is severe in nature that requires a fairly immediate judgment or decision as to management, and it doesn’t always mean surgery is necessary, but many of the causes do require surgical intervention. It is essential that the problem is diagnosed quickly and accurately, as many of the problems that cause an acute abdomen can be life-threatening.
Surgical emergency is a medical emergency which requires immediate surgical intervention as the only way to solve the problem successfully as in acute trauma, acute appendicitis, ruptured aortic aneurysm, bowel obstruction, internal bleeding, gastrointestinal perforation, and acute mesenteric ischemia.
Diagnostic laparoscopy is the technique which can visualize the abdomen and, by establishing an adequate diagnosis, permits the surgeon to plan the right abdominal approach.
Emergency laparoscopy is the laparoscopic operation which should be performed without any delay in life threatening situations, and it should be done by a specialist laparoscopic surgeon and he should be able to perform laparoscopic surgery, once pathology is diagnosed inside the abdomen.
By history the gynaecologists were the first to start laparoscopy in the diagnosis and treatment, but since 1990s a lot of general surgeons have started to use this technique in the abdominal urgency Initially laparoscopy was tried for elective surgery only, but with the advent of new technology many of the emergency surgeries are possible by laparoscopic method. Emergency Laparoscopic treatment of acute abdomen was first proposed by Philippe Mouret in 1990. The diagnostic value of emergency laparoscopy has been proved since the 1950s-1960s, but the emergency therapeutic application of the laparoscopic technique for the surgical treatment is recent.
Emergency laparoscopy has many benefits as it is diagnostic and therapeutic at the same time, it enables a better evaluation of the peritoneal cavity than that obtained by the standard laparotomy as it allows rapid and thorough inspection of the para-colic gutters and the pelvic cavity that is not possible with the open approach, less post-operative complications like wound infection, adhesion and hernias, less post-operative pain, short hospital stay, faster recovery and hence lower health service costs.
As surgeons gained more experience with laparoscopic techniques and technical advances in instrumentations were made some relative contra-indications as previous surgery, morbid obesity, severe cardiac, vascular, and pulmonary disease, and pregnancy have not been considered contraindications to laparoscopic surgery provided there is careful monitoring and thoughtful anaesthesia. Rather, laparoscopy has resulted in a much smoother post-operative course.
Laparoscopy has been reported as a therapeutic tool in selected trauma patients for example repair of diaphragmatic lacerations with sutures, suturing of gastrointestinal perforations, hemostasis of liver and splenic lacerations, resection of small bowel and colon, splenectomy, and distal pancreatectomy. For the repair of solid visceral injuries, there are the totally laparoscopic procedure, the laparoscopically assisted procedure, and hand assisted laparoscopic surgery.The argon beam coagulator, fibrin glue, topical hemostatic agent, and absorbable mesh may be beneficial for hepatic and splenic lacerations. Laparoscopic repair of bowel injuries can be performed using suture or staples. Primary suture repair of a small bowel injury would be amenable by a totally laparoscopic procedure.
Laparoscopic approach for perforated peptic ulcer is a safe emergency procedure and technically feasible, morbidity & mortality rate in compare with open surgery is acceptable meanwhile postoperative comfort is significantly more. All duodenal ulcer perforation without extensive peritonitis is indicated for Laparoscopic treatment.
Laparoscopy in small bowel obstruction doesn’t always represent only a therapeutic act, but it is always a diagnostic act, which doesn’t interfere with abdominal wall integrity.
Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The main evidence-based recommendation from the EAES was: “It is not possible to recommend laparoscopic adhesiolysis as an alternative to the laparotomic approach for small bowel obstructions (C grade)”, but the laparoscopic adhesiolysis can avoid laparotomy, which is itself a cause of new adhesions and bowel obstruction.
The complications can be divided into two categories; non specific laparoscopic complications; those might occur in any laparoscopic procedure and are further classified into ; those specifically attributable to the insufflation of gas into a body cavity (physiological), and Those due to specific instruments used to carry out the laparoscopic procedure and are not unique to the kind of surgery but common for the procedure in general, like Veress needle insertion, trocar placement. Surgical specific complications which might occur for certain procedure in particular like injury to important structures as vessels and nerves.
The surgeon must have adequate training and experience in laparoscopic surgery before intending to perform any procedure independently. He should be familiar with the equipment, instrument and energy source. The outcome of any laparoscopic procedure greatly depends on the experience of the surgeon. The surgeon should select the technique he feels he is performing safely.