A Clinical Analysis of 2503 Emergent Explo-Laparotomic Cases

ABSTRACT

BACKGROUND AND METHODS: We have tried to analyze the clinical findings from a total of 2503 emergent explo-laparotomic cases which had been performed during ten years from March 1989 to February 1999 at the Deptartment of General Surgery of Inchon Medical Center, Public Corporation. RESULTS AND CONCLUSIONS: 1) The total 2503 emergent explo-laparotomic cases were composed of 1992 cases (79.6%, most common) of acute appendicitis, 235 cases (9.4%) of panperitonitis, 93 cases (3.7%) of intestinal obstruction, 62 cases (2.7%) of hemoperitoneum (more than 2000 cc, without panperitonitis), 40 cases (1.6%) of gall bladder empyema, 16 cases (0.6%) of upper gastrointestinal bleeding, 15 cases (0.6%) of wound evisceration, 10 cases (0.4%) of incarcerated inguinal hernia, 9 cases (0.4%) of intra- peritoneal abscess, 9 cases (0.4%) of pancreatic abscess, 7 cases (0.3%) of septic cholangitis, 6 cases (0.2%) of diverticulitis, 5 cases (0.2%) of intussusception, 2 cases (0.1%) of liver abscess and 2 cases (0.1%) of retroperitoneal abscess. 2) Of the 1992 emergent explo-laparotomic cases which had been performed due to acute appendicitis, there were 1826 cases (more than 90%) of simple appendicitis, 95 cases of perforated appendicitis, and 71 cases of periappendiceal abscess. 3) The 237 explo-laparotomic cases of panperitonitis contained 147 cases (62%) of non-traumatic (by disease) panperitonitis and 90 cases (38%) of traumatic panperitonitis. Of the 147 cases of non-traumatic panperitonitis, there were 91 cases (62%, most common) of duodenal ulcer perforation, 21 cases of stomach ulcer perforation, 6 cases of bile peritonitis, 5 cases of colon cancer perforation, etc. Of the 90 cases of traumatic panperitonitis, there were 42 cases of small bowel rupture, 12 cases of colon rupture, 9 cases of stomach rupture, 8 cases of duodenal rupture, etc. 4) The 97 explo-laparotomic cases of intestinal obstruction were composed of 34 cases (35%, most common) of adhesive ileus, 18 cases of duodenal obstruction (16 cases due to duodenal ulcer obstruction, 2 cases due to periampullary cancer invasion), 16 cases of colon cancer obstruction, 7 cases of cancer peritoneii, 6 cases of incarcerated inguinal hernia, 4 cases of small bowel ileus, 3 cases of intestinal tuberculosis, etc. 5) The 61 cases of hemoperitoneum contained 56 cases (92%) of traumatic hemoperitoneum and 5 cases (8%) of spontaneous hemoperitoneum. Of the 56 cases of traumatic hemoperitoneum, there were 20 cases of splenic rupture, 18 cases of mesenteric tearing, 11 cases of liver laceration, etc. 6) The 148 cases of emergent explo-laparotomy for trauma contained 114cases (77%) due to blunt trauma and 34 cases (23%) due to penetrating trauma. Of the 114 emergent explo-laparotomic cases due to blunt trauma, there were 37 cases (32%, most common) of small-bowel rupture, 19 cases (17%, 2nd common) of splenic rupture, 17 cases of mesenteric tearing, 12 cases of colon rupture, 8 cases of liver laceration, 8 cases of duodenal rupture, 3 cases of stomach rupture, 3 cases of pancreas rupture, etc. Of the explo-laparotomic cases due to penetrating trauma, there were abdominal wall only penetration (most common), stomach, small bowel, liver organ injury, etc, in decreasing order.