Acute abdominal pain and the emergency laparoscopy – a diagnostic dilemma for the surgeon or gynaecologist? — YRD
  1. Schedule
  2. Session 3 - Free Communications : Chairman's Choice
  3. Acute abdominal pain and the emergency laparoscopy – a diagnostic dilemma for the surgeon or gynaecologist?

Acute abdominal pain and the emergency laparoscopy – a diagnostic dilemma for the surgeon or gynaecologist? (2412)

Jess McMicking 1 , Swati Mahajan
  1. Bankstown Hospital, Bankstown, NSW , Australia

Background

Acute abdominal pain is a common presenting complaint in reproductive aged females. The differential diagnosis can be complex, including both gynaecological and non-gynaecology pathology such as ruptured ovarian cysts, salpingitis, ectopic pregnancy, appendicitis and other gastrointestinal conditions1. Laparoscopy is an important diagnostic tool used to reveal intra-abdominal pathology, as well as valuable modality for treatment2,3. The decision to pursue surgery can be difficult as well as challenging in the setting of surgeon versus gynaecologist. Given that surgical complications are associated with a laparoscopy, it is important to have high accuracy rate for predicting the diagnosis and decision for surgery be taken seriously.

Aim

The objective of this study was to evaluate the emergency laparoscopy cases and assess the accuracy in diagnosis prior to surgery.

Methods

This was a retrospective cohort study over a 3 year period that included all reproductive aged women who underwent an emergency laparoscopy at a secondary hospital in Sydney. An emergency laparoscopy was defined as an acute presentation of abdominal pain, with subsequent laparoscopy being performed under emergency conditions within 72 hours. The data collected included the type of primary surgeon, intraoperative and histological findings, presence of further intraoperative consultation, if the pathology had been accurately predicted preoperatively, if negative findings were found, and any diagnostic investigations undertaken prior to the decision for surgery. 

Results

A total of 83 cases were identified. The primary operator was 58% gynaecology team and 42% surgical team. Out of the surgical female patients, only 54% had surgical pathology, 20% required gynaecology intraoperative input and 14% had gynaecology pathology that was handled solely by the surgeons. In comparison, 90% of the gynaecological patients had gynaecology pathology found during surgery. The majority of gynaecology patients also underwent a pelvic ultrasound prior to the decision made for theatre, whereas this was not the case for the surgical patients. 

Discussion

This study reinforces that in an acute abdomen setting, both surgical and gynaecological pathology can be responsible. It is acknowledged that the applicability of these findings is limited given the design of the study, however important learning lessons still stand. If a patient undergoes both blood tests and imaging prior to surgery, then there is greater likelihood of is providing an accurate diagnosis for gynaecology pathology. Gynaecologists as well as gynaecology trainees must also be aware of the potential for being called to an intraoperative consultation in the setting of acute abdominal pain.

  1. Becker J, Graaff J, Vos C. Torsion of the ovary: a known but frequently missed diagnosis. European Journal of Emergency Medicine. 2009; 16: 124-126.
  2. Phillips A, Jones A, Sargen K. Should the Macroscopically Normal Appendix be Removed During Laparoscopy for Acute Right Iliac Fossa Pain when No other explanatory pathology is found? Surgical Laparoscopy Endoscopy and Percutaneous Techniques. 2009; 19: 392-396.
  3. Ahmad T et al. Experience of Laparoscopic Management in 100 Patients with Acute Abdomen. Hepato-Gastroenterology. 2001; 48: 733-736.