H. R. Satish Kumar1 , Virupaksha K. L2
AIMS AND OBJECTIVES: “To study the efficacy of diagnostic laparoscopy is undiagnosed chronic abdominal pain’’ in a prospective study of diagnostic laparoscopy in identifying the etiology of undiagnosed chronic abdominal pain and to study the accuracy of diagnostic laparoscopy in evaluating the undiagnosed chronic abdominal pain. METHODS: The study was conducted in JSS Hospital, Mysore during study that is from July 2006 to 2008. 50 patients with undiagnosed chronic abdominal pain satisfying the inclusion and exclusion criteria were included in this study. After a details history and clinical examination of the abdomen, Patients were subjected to various investigation viz, radiological investigation X-ray erect abdomen, USG abdomen and pelvis, CT scan and endoscopic studies – UGI endoscopy and colonoscopy. After initial assessment they were subjected to laparoscopy. The age/sex distribution, clinical presentation, the investigations the laparoscopic procedures were all evaluated and compared with standard literature. RESULTS: A total of 50 cases were enlisted in this study, recurrent appendicitis accounted for 32% next common was postop adhesions accounted for 26%. Maximum distribution was observed in the age group of 21-40 years (56%) followed by 41-60 years (28%), with the age range being 12-80 years. Among them 19 were male patients and 31 female patients. With the male to female ratio being 1:1.6. In our study for undiagnosed chronic abdominal parts abdominal parts obviously all investigations studies will be inconclusive. Radiological studies including x-ray erect abdomen, USG abdomen & pelvis, CT scan. X-rays and USG done in all 50 patients but all are negative. CT scan done only 2 patients (4%) is negative. Endoscopic studies done wherever applicable, UGI endoscopy done in 33 patients (66%), colonoscopy done in 2 patients (4%) but are negative. After diagnostic laparoscopy recurrent appendicitis and post-operative adhesions both constituted 58%. Tuberculous peritoneum diagnosed in 10%. Secondaries in liver diagnosed in 8%, retro duodenal mass diagnosed in 2%, chronic cholecystitis diagnosed in 2%, post-operative adhesions involving female sex more (38.7%), male sex (5.3%). Normal study is 20%. Laparoscopic procedures done simultaneously wherever feasible. Appendicectomy done in 38%, adhesiolysis done in 25%, biopsy taken in 20%, cholecystectomy done in 2%, nothing done in 20%. So total simultaneous therapeutic procedures done in 66%. After diagnostic procedures diseases are confirmed by HPE reports then patients were treated accordingly. HPE done for both therapeutic and diagnostic specimens. All appendix except 3, and gall bladder specimens shows chronic inflammation. 3 appendix specimens show normal study. Specimens took for diagnostic purposes (20%) shows, tuberculosis 10%, metastatic adenocarcinoma 8%, Hodgkin’s lymphoma 2%. In our study morbidity is 6% and no mortality. CONCLUSION: In our study recurrent appendicitis was the commonest cause for chronic pain abdomen, who presented with right lower quadrant pain. Next common is post-operative adhesions. Apart from diagnostic procedures, simultaneous therapeutic procedures can also be done preventing unnecessary laparotomy. No cases required conversion to laparotomy. An exclusion of significant disease in patients with undiagnosed chronic abdominal pain not only gives peace of mind bur also avoids further costly and uncomfortable investigations. Laparoscopy is very safe, quick and elective as a major diagnostic tool in unexplained chronic abdominal pain. Laparoscopy is a very accurate mode of diagnosing abdominal pain with high sensitivity and specificity.