Laparoscopy versus abdominal ultrasonography and diagnostic peritoneal lavage in abdominal trauma

The increasing incidence of severely injured patients with multiple organ injuries requires rapid and accurate diagnostic techniques. The accurate assessment of the injuries and the priority of treatment are factors that influence eventual outcome. Diagnostic peritoneal lavage and ultrasonography are the diagnostic modalities used in patients without obvious urgent indications for laparotomy after blunt trauma to the abdomen. From this study, U/S is non-invasive, rapid, available, without complication, but it inadequate investigation, in such patient, it also complemented by peritoneal lavage which considered as invasive but it rapid, cheep and accurate test in cases of abdominal trauma. So we conclude that, in patients with abdominal trauma, diagnostic peritoneal lavage and ultrasonography as well as laparoscopy are not competing procedures but are rather complementary in the evaluation of blunt abdominal trauma patients who are with or without indications for laparotomy. In our opinion, laparoscopy is more diagnostically accurate than lavage as well as ultrasonography. It is fast and safe examination which can be performed when its indicated. The number of unnecessary abdominal explorations in severely injured patients can be reduced to a negligible figures, thus decreasing morbidity, hospitalization time and costs

Incidental appendectomy with cholecystectomy

Opinions vary considerably among surgeons as to the advisability of incidental removal of the appendix during laparotomy for some other indications including cholecystectomy [Zbar et al., 1993], jejunoileal bypass for morbid obesity [Kelly, 1902], right inguinal herniorrhaphy [Ring-Morzik et al., 1993], cesarean section, hystrectomy, post partum tubal ligation [Wilson et al., 1973] and exploratory laparotomy. The frequent notation of abnormal pathologic findings in an apparently normal appendix support its elective removal [Lowery and Lenhardt, 1962]. 30% of these appendices had significant histopathological changes. The incidental removal of the appendix cause no increase in the incidence of wound infections in patients who underwent cholecystectomies [Arango et al., 1994]. If the patient in good general condition with an average surgeon, incidental appendectomy when tempered carefully appears to be innocuous favorable cases seems to be indicated