Laparoscopy; indications in the diagnosis of abdominal pain

To identify the various acute and chronic abdominal conditions presenting as non specific abdominal pain in which diagnostic laparoscopy was indicated to establish a definite diagnosis and treatment. Descriptive study. Surgical unit-I of Rawalpindi General Hospital Rawalpindi. From February 2005 to February 2006. All patients who presented with non specific abdominal pain and fulfilled the inclusion criteria were included in the study. The sample size was 150 cases, out of which 71 [47%] were male and 79 [53%] were female. Mean age was 32.65_17 years. Fifty five [36%] patients were admitted through emergency department while 95 [63%] were admitted through OPD. Four main groups were identified who presented with nonspecific abdominal pain in which diagnostic laparoscopy was indicated. These were patients with acute or chronic inflammatory conditions [66%], acute or chronic intestinal obstruction [14%], patients with blunt/penetrating abdominal trauma [11%], and patients of intra abdominal tumor [9%]. Out of these 150 cases, 53 cases [35%] had laparoscopy to confirm the diagnosis [diagnostic laparoscopy] while the remaining 97 cases [65%] had both the diagnostic as well as therapeutic laparoscopy. Mean hospital stay was 1.7 Days. The study has demonstrated the various acute and chronic abdominal conditions in which laparoscopy in indicated and proved to have higher diagnostic and therapeutic yield, and hence improved the management of these patients

Bouveret's syndrome

Gastric Outlet Obstruction [GOO] due to impaction of a gallstone in the duodenum after migration through a bilioduodenal fistula is known as Bouveret's syndrome. Its clinical symptoms are entirely vague and nonspecific. Because of its rarity, insidiousness and unpredictable symptomatology, Bouveret's syndrome is never thought of in the differential diagnosis as aetiology of gastric outlet obstruction. Recent advances in fiberoptics technology, advent of modern imaging modalities and minimally-invasive techniques like endoscopy and laparoscopy has brought a great revolution in the management of Bouveret's syndrome and have tremendously decreased morbidity and mortality associated with this rare clinical entity

Hypertrophic pyloroduodenal tuberculosis

Hypertrophic pyloroduodenal tuberculosis is a rare cause of Gastric Outlet Obstruction [GOO] often forgotten in the differential diagnosis of gastric outlet obstruction. Since laboratory and radiological investigations often prove inconclusive in reaching the diagnosis of hypertrophic pyloroduodenal tuberculosis, surgery has a key role in the management of hypertrophic pyloroduodenal tuberculosis. Postoperative anti-tuberculosis chemotherapy [ATT] becomes imperative for complete resolution of hypertrophic pyloroduodenal tuberculosis. This case report describes the condition and management in a young girl