The role of peritoneoscopy in the diagnosis of acute abdominal conditions
James T. Diehl, M.D.
Department of General Surgery
Michael S. Eisenstat, M.D.
Sheldon Gillinov, M.D.
Dinkar Rao, M.D.
During its 70-year history, peritoneoscopy has been widely used in the diagnosis and treatment of pelvic disorders and has been shown to be an accurate diagnostic procedure associated with low morbidity and a high degree of acceptance by the patient. It has recently become popular as a direct means of studying patients with suspected intraabdominal malignancy and as a valuable diagnostic adjunct in assessing the patient with heaptobiliary disease. Despite its usefulness, peritoneoscopy has not played a prominent role in evaluating the patient with acute abdominal pathology.
Our interest was stimulated by the reports of Carnevale et al1 and Gazzaniga et al2 on the use of peritoneoscopy in the evaluation of abdominal injuries. We report our experience with the procedure and the indications for its use in patients with blunt abdominal trauma and patients with suspected acute appendicitis.
Patients and methods
The technique of peritoneoscopy may be mastered with relative ease. In our series the procedure was performed in the operating room with full aseptic technique with the patient under general anesthesia. The procedure may be done under local anesthesia in the intensive care unit or even in the emergency room as described by Sherwood et al.3 A 1-cm infraumbilical skin incision was used for introduction of the spring-loaded pneumoneedle and subsequent placement of the peritoneoscope. Pneumoperitoneum was established with carbon dioxide gas. Adverse respiratory and hemodynamic effects of overinsufflation were avoided by keeping intraabdominal pressure below 20 mm Hg. Visualization of various structures was facilitated through positioning of the . . .