Role of laparoscopy in the evaluation of abdominal trauma

This prospective study was designed to determine if laparoscopy is a safe and accurate method for abdominal evaluation in the trauma patient. Thirtytwo patients who presented with blunt or penetrating trauma and who were scheduled for celiotomy based on clinical evaluation constituted the study group. The patients underwent diagnostic laparoscopy prior to exploratory celiotomy. One of 6 (16%) patients with blunt abdominal trauma and 5 of 26 (19%) patients with penetrating abdominal trauma had significant injuries that were found at the time of operation but not visualized during laparoscopy. The missed injuries involved the liver, pancreas, stomach, duodenum, small bowel, small bowel mesentery, ureter, and urinary bladder. The correlation between the laparoscopist and the trauma surgeon as to the need to perform a celiotomy was 97%. Complications occurred in 2 of 32 patients. Eleven patients with anterior abdominal penetrating injuries had no evidence of penetration of the abdominal cavity at laparoscopy, and had no evidence of injury at celiotomy. We concluded that (1) there are areas within the abdominal cavity that cannot be accurately visualized with laparoscopy; (2) the evaluation of penetration of the peritoneal cavity from anterior penetrating injury appears to be accurate; (3) a number of injuries were not identified; and (4) further investigation of this procedure for the evaluation of abdominal trauma is required to assess its safety and accuracy.