The diagnostic laparotomy

摘要

Indications and Rationale for Surgery: Many indications exist requiring a diagnostic laparotomy. Some are emergencies, while others can be approached in a more deliberative style. Emergency indications are frequently described as "acute abdomen", with surgery only delayed to insure that the patient is treated medically sufficiently to increase the patient's likelihood of survival of anesthesia and surgery. The consistent sign of an acute abdominal disease is pain. This may be reflecting infection/inflammation in the abdomen, or nausea. Patients and syndromes have a wide range of responses reflecting acute abdominal disease. Diseases producing an "acute abdomen" include hemorrhage non-responsive to volume replacement, or sepsis, or either an obstruction or perforation of a hollow viscus organ. Obstructions include such a wide variety of syndromes as gastric dilatation/volvulus, urethral or ureteral calculi, irreducible abdominal hernia, gastrointestinal foreign body, diaphragmatic rupture, and dystocia (C-section). Obstructions can totally occlude a viscus lumen, or produce a functional obstruction to flow. Perforations of viscus organs include rupture of the urinary tract, biliary system, gastrointestinal tract, and penetrating trauma. These perforations produce either septic or chemical peritonitis. Some common indications are "near-perforations" such as a pyometra and toxic megalocolon.