Role of laparoscopy in the management of chronic unexplained lower abdominal pain

Patients with chronic lower abdominal pain in whom routine investigations fail in accurate diagnosis, continue to pose a challenge to the clinician. In many patients laparotomy is the only alternative. The aim of this study was to evaluate and establish role of laparoscopy in management of unexplained chronic lower abdominal pain. Over a period of 24 months we prospectively managed 52 patients presented with unexplained chronic lower abdominal pain by laparoscope. Laparoscopy yielded positive findings in 39[75%] of these patients. Chronic appendicitis, intrabdominal adhesions and gynecological problems were the major findings. Therapeutic procedures were performed in 40 patients [laparoscopically in 35 patients]. There were no major complications following diagnostic laparoscopy. Laparoscopy is safe and effective in management of undiagnosed chronic lower abdominal pain

Adhesive small bowel obstruction: early dicision making

A 2-year study of 38 patients presenting with adhesive small bowel obstruction is carried out. They were 20 males and 18 females, their ages ranged between 20 and 56 years[mean 34.5]. The onset of symptoms was from 2 weeks to 11 years after the last celiotomy [mean 1 4/12 year]. The main presentation was abdominal pain [78.9%], abdominal distension [78.9%], Nausea/Vomiting [76.3%] and tachycardia [84.2%]. Full clinical assessment, laboratory studies and plain abdominal roentogram were done for all patients. Gastrograffin follow through series is done for 37 patients. Thirty patients [78.9%] have free passage of gastrograffin through whole gut, have their attacks subsided within 1-2 days by non-operative treatment and all were discharged in 2-4 days. One patient had emergency laboratory on basis of clinical data and plain abdominal roetogram suggestive of intestinal strangulation. Seven patients explored on basis of follow through study conclusive of complete obstruction. Their hospital stay ranged from 4-8 days. No mortality was detected in the series. We conclude that gastrograffin follow through series early in adhesive small bowel obstruction help in early decision making and may have some therapeutic role in partial small bowel obstruction. Also, early surgical intervention, when indicated, reduces mortality and morbidity