PubMed · 4600461
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I Tejkowska-Goślicka, J Stoczyński, M Guzowski, H Galińska. 1974-06-01. [Multiple hepatic rupture].. https://pubmed.ncbi.nlm.nih.gov/4600461/
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A 27-year-old female patient presented in our clinic 14 hours after onset of acute lower abdominal pain during sexual intercourse. Sonography showed ascites around the uterus and structures suspected to be clotted blood. Diagnostic laparoscopy showed in the abdomen about 400 ml of clotted blood: sources of bleeding were small injuries of the left sacro-uterine ligament. Therapy was not necessary, except careful rinsing since hemostasis was already complete. It is important to consider abdominal injuries in cases of abdominal pain after sexual intercourse, even if vulvar or vaginal injuries are absent.
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PURPOSE: To assess the therapeutic potential of emergent laparoscopy in the trauma setting, a retrospective review was performed in a busy urban trauma center. PATIENTS AND METHODS: Between December 1991 and October 1993, 133 hemodynamically stable patients with suspected abdominal injury were evaluated laparoscopically. All laparoscopic procedures were performed in the operating room under general anesthesia. Mechanism of injury was stab wound (58), gunshot wound (57), and blunt trauma (18). No significant injuries were found in 72 patients (54%), and these patients received no further treatment. On the basis of laparoscopic findings, 52 patients underwent formal exploratory laparotomy. Surgical exploration confirmed the presence of significant injuries in 44 of the 52 patients (85%). Therapeutic laparoscopy was performed in 6 patients (5%) for diaphragm repair (4), gastrotomy repair (1), and splenorrhaphy (1). Additionally, 10 patients underwent laparoscopy-guided blood salvage for autotransfusion during laparoscopic evaluation of blunt trauma. Three small-bowel enterotomies were repaired during minilaparotomy. RESULTS: No significant injuries were missed as a result of our use of laparoscopy in trauma assessment. Complications--trocar enterotomy, trocar laceration of the inferior epigastric artery, and transient hypotension--occurred in 3 patients secondary to the use of laparoscopy. CONCLUSIONS: Trauma laparoscopy is a safe method for the evaluation of selected patients with abdominal trauma and can reduce the number of negative and nontherapeutic trauma laparotomies performed. Limited therapeutic intervention is possible in a small number of patients.