‘’TO CORRELATE THE DIAGNOSTIC LAPAROSCOPIC FINDINGS WITH THE CLINICAL AND RADIOLOGICAL FINDINGS IN CHRONIC ABDOMINAL PAIN PATIENTS.’’
Main Article Content
Keywords
chronic abdominal pain, exploratory laparotomy, diagnostic laparotomy, bowel obstruction, tubercular abdomen
Abstract
Background and Objective: Chronic abdominal pain is defined as continuous or intermittent abdominal discomfort/pain lasting for more than 3 months. Diagnostic laparoscopy is an emerging tool in diagnosis of chronic non-specific abdominal pain, the diagnosis of which remains uncertain despite employing the requisite laboratory and non-invasive imaging investigations. The aim of our study was- to correlate the findings of diagnostic laparoscopy with the clinical and radiological findings.
Materials and Methods: this is a prospective single centre study done in Department of Surgery of Sanjay Gandhi Memorial Hospital associated with S.S. Medical College, Rewa (M.P.) during the period of 1st June 2016 to 31st May 2017. Our study was carried out on 48 patients admitted in surgical wards. All patients having chronic abdominal pain were included in the study, and patients with acute abdominal pain, with an uncorrectable coagulopathy, or uncorrectable hypercapnia and pregnant females were excluded from the study. Detailed history, examination, baseline blood, and radiological investigations were done to reach to diagnosis. Patients were subjected to diagnostic laparoscopy, and the necessary surgical therapeutic interventions during laparoscopy were employed as per the etiology after taking informed written consent. The usefulness of laparoscopy to confirm the diagnosis and clinical management of these patients of chronic abdominal pain was evaluated.
Result: Our study was carried out on 48 patients admitted in surgical wards. The incidence of chronic abdominal pain was almost equal in both genders. Peak incidence was seen in the age group of 31–40 years. Abdominal pain was present in all cases 48/48 (100%) as a chief complaint followed by abdominal distension in 17/48 (35.41%). Average duration of pain was 10.92 ± 5.88 months. 18 (37.5%) showed normal USG findings, 15 (31.25%) had dilated bowel loops and bowel thickening, 6(12.5%) had ascites, 4 (8.33%) had mesenteric lymphadenopathy, while gaseous distension was seen in 2 (4.17%). CT of abdomen was done in 11(22.9%) patients. 10(20.8%) patients showed pathological findings (ascitis, mesenteric fat thickening, lymphadenopathy, multiloculated collection, GB mass, Dilated bowel loops, pleural effusion, bowel thickening). Koch’s abdomen was the most common finding during laparoscopy followed by chronic/recurrent appendicitis. Definitive diagnosis was made in 43 patients, and 38 patients had shown resolution of pain after diagnostic laparoscopy.
Conclusion: Laparoscopy offers a definitive diagnosis in a large number of patients of chronic abdominal pain and also provides therapeutic intervention. An early resort to laparoscopy can resolve the diagnostic dilemma and early treatment can be instituted.
References
2. Peters AA, Van den Tillaart SA. The difficult patient in gastroenterology: Chronic pelvic pain, adhesions, and sub occlusive episodes. Best Pract Res Clin Gastroenterol 2007;21:445-63.
3. Van Goor H. Consequences and complications of peritoneal adhesions. Colorectal Dis 2007;9:25-34.
4. Fayez JA, Toy NJ, Flanagan TM. The appendix as the cause of chronic lower abdominal pain. Am J Obstet Gynecol 1995;172:122-3.
5. Dumont RC, Caniano DA. Hypokinetic gallbladder disease: A cause of chronic abdominal pain in children and adolescents. J Pediatr Surg 1999;34:858-61.
6. Johnson CD. ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder. BMJ 2001;323:1170-3.
7. Mertz HR. Irritable bowel syndrome. N Engl J Med 2003;349:2136-46.
8. Tack J, Lee KJ. Pathophysiology and treatment of functional dyspepsia. J Clin Gastroenterol 2005;39:S211-6.
9. Abell TL, Werkman RF. Gastrointestinal motility disorders. Am Fam Physician 1996;53:895-902.
10. Lindsetmo RO, Stulberg J. Chronic abdominal wall pain a diagnostic challenge for the surgeon. Am J Surg 2009;198:129-34.
11. Costanza CD, Longstreth GF, Liu AL. Chronic abdominal wall pain: Clinical features, health care costs, and longterm outcome. Clin Gastroenterol Hepatol 2004;2:395-9.
12. Von Korff M, Dworkin SF, Le Resche L, Kruger A. An epidemiologic comparison of pain complaints. Pain 1988;32:173-83.
13. Tulaskar N, Nichkode P, Dasgupta S, Choudhary A, Zamad R, Panchbhai K, et al. Evaluation of role of laparoscopy in chronic abdominal pain. Int J Bio Med Res 2013;4:3230-3.
14. Rathod P, Gujar N, Hosmani I, Sachin DM. Study to evaluate the role of laparoscopy in chronic abdominal pain. Int J Curr Res 2014;6:6376-9.
15. Kumar S. To study the efficacy of diagnostic laparoscopy in chronic abdominal pain. J Evid Based Med Healthcare 2014;1:1771-87.
16. Saxena P. The role of laparoscopy in diagnosis of patients with chronic abdominal pain. Int Surg J 2017;4:326-33.
17. Chaphekar AP, Vankipuram S, Nawalkar PR, Sutar SA, Devlekar SM. Does laparoscopy have a role in chronic abdominal pain? Int J Contemp Med Res 2016;3:2582-5.
18. Chao K, Farrell S, Kerdemelidis P, Tulloh B. Diagnostic laparoscopy for chronic right iliac fossa pain: A pilot study. Aust N Z J Surg 1997;67:789-91.
19. Salky BA, Edye MB. The role of laparoscopy in the diagnosis and treatment of abdominal pain syndromes. Surg Endosc 1998;12:911-4.
20. Nar AS, Bawa A, Mishra A, Mittal A. Role of diagnostic laparoscopy in chronic abdominal conditions with uncertain diagnosis. Niger J Surg 2014;20:75-8.
21. Klingensmith ME, Soybel DI, Brooks DC. Laparoscopy for chronic abdominal pain. Surg Endosc 1996;10:1085-7.
22. Arya PK, Gaur KJ. Laparoscopy, A tool in diagnosis of lower abdominal pain. Indian J Surg 2004;66:216-20.
23. Karvande R, Kamble R, Kharade M. A study of role of diagnostic and therapeutic laparoscopy in chronic and recurrent abdominal pain. Int Surg J 2016;3:1336-40.
24. Paajanen H, Pulkunen K, Waris H. Laparoscopy in chronic abdominal pain. J Clin Gastroentrol 2005;39:110-4.
25. Kumar A, Sarwar MY, Pandey NK. Role of diagnostic laparoscopy in nonspecific chronic abdominal pain: Experience of 100 cases. J Evol Med Dent Sci 2013;2:9361-6
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Dr Suvriti Chaurasia
Senior resident, Department of Cardiothoracic and Vascular Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India 482003
Dr Satyam Chaurasia
Designation Senior resident, Department Pathology, Government Medical College, Satna, Madhya Pradesh, India 485001