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Peritoneoscopy is being recognized as a valuable diagnostic procedure. In the few cases which are difficult to diagnose without exploratory laparotomy endoscopy of the peritoneal cavity and its contents may prove advantageous.

Although many uses for the peritoneoscope have been described, its practical use seems to be limited to the investigation of (1) ascites in the differential diagnosis of cirrhosis of the liver, generalized abdominal carcinomatosis, and tuberculous peritonitis and (2) liver disease, especially with hepatomegaly.

The value of the procedure is necessarily limited by what can be seen in the peritoneal cavity. The liver, falciform ligament, omentum, anterior surfaces of the small and large intestines, fundus of the gall-bladder, pelvic viscera, parietal peritoneum, and occasionally the cecum and appendix can be seen.

Most authors agree that peritoneoscopy is contraindicated in (1) acute inflammation in the abdominal cavity, lest the infection spread; (2) distention, which increases the likelihood of perforating the bowel; and (3) the presence of known adhesions, although previous surgery does not absolutely contraindícate the procedure. In several cases adhesions from previous surgery in the upper right quadrant prevented observation of the part in question. Although it is not a contraindication, obesity may be troublesome since a large, fatty omentum may float over or adhere to the visceral or parietal peritoneum or both.

Preoperative preparation is the same as that for abdominal exploration. The abdominal wall is shaved, the bladder is emptied, and sedation adequate to allay apprehension and reduce susceptibility to pain is administered.

In the operating. . .



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