Diagnostic Laparoscopy in the Management of Post Appendectomy Pain Right Iliac Fossa

摘要

OBJECTIVE: To determine the cause for pain right iliac fossa (RIF) after Appendectomy by Diagnosticlaparoscopy in patients with normal investigations .STUDY DESIGN: A Prospective Observational studyPLACE AND DURATION: Surgical A ward, Khyber Teaching Hospital Peshawar, from April 2009 to May2011.METHODOLOGY: All those patient who continued to have pain in the RIF, more than 6 weeks afterappendectomy,or more than 3 opd visits and normal investigations of genitourinary system andabdominopelvic ultrasound were included. Patients with symptoms of genitourinary system and pelvicinflammatory disease(PID) were excluded.RESULTS: Fifty three patients were included in the study . Age range was from 15-42 years with 23 (43.39%) patients aged less than 20 years, 15 (28.30%) 21-30 years,11 (20.75%) 31-40 years and 4 (7.54%)were above 40 years. Males were 19 (35.84%) and 34 (64.15%) were females, In 41 (77.35%) casesappendectomy had been done in emergency as they presented as acute appendicitis and 12 (22.64 %) wereelective cases. Appendectomy was performed by open method in 45 cases (84.90%) and laparoscopically in8 (15.09%) patients Diagnostic Laparoscopy was done in all patients and the findings included, adhesions in21 cases (39.62%) tuberculosis in 9 cases (16.98%) , PID in 7 cases (13.20%) , ovarian cyst in 5 cases(9.43%) and a long appendicular stump in 2 (3.77%) and 1 (1.88%) terminal ileitis, while no cause was foundin 8 (15.09%) patients .CONCLUSIONS: Post appendectomy pain RIF can be due to postoperative adhesions, pelvic inflammatorydisease, ovarian cysts and abdominal tuberculosis. Diagnostic laparoscopy should be done to find out thecause in patients with inconclusive investigations.