Clinical Diagnosis and Per-Operative Findings Non-Traumatic emergency Laparotomy-A Study of 200 Cases

Abstract

Introduction: In surgical wards, most of the patients of emergency admission present with abdominal complaints, for which laparotomy is indicated in many cases. Sometimes the diagnosis is obvious and can be done by taking a detailed history and careful clinical examination. Objective: To assess the clinical evaluation of non-traumatic emergency laparotomy, a study of 200 cases. Materials and Methods: It is a prospective study. Two hundred cases of nontraumatic emergency laparotomy patients were studied in Dhaka Medical College Hospital during the period of July 2007 to June 2008. Limited investigations dictated by the clinical conditions were done. Plain X-ray abdomen was the most frequently used investigation alone with blood count, serum amylase and ultrasonogram of abdomen. Clinical diagnosis was made depending on clinical findings and the results of investigations. Results: In total, 200 cases of non-traumatic emergency laparotomy, 139(69.5%) were male and 61(30.5%) were female. Among the 200 patients age of them ranged from 12 to 75 years. Most of them were in the age group of 10 to 50 years of age. In acute appendicitis, pain followed by vomiting in 83.33 of cases, whereas in perforation of duodenal ulcer this incidence was only 14.28%.Pain and fever predominates 51.5% followed by severe abdominal pain 47%.The most common diagnosis of this series was acute appendicitis (48%), followed by duodenal ulcer perforation (24%). Ileal perforation (96) and largegut obstruction (5.5%) occupied third and fourth position respectively. Above study shows that males are more affected by acute non traumatic abdominal diseases and undergone laparotomy. Diagnostic accuracy in respect of clinical diagnosis was highest in case of perforated peptic ulcer (91.07%). In case of acute appendicitis, it was 87.5%. In case of intestinal obstruction, it was 88.88%. Conclusion: The inconsistency between clinical diagnosis and peroperative findings can be minimized with more meticulous ....