Ahmed et al used laparoscopy to evaluate patients with possible penetrating wounds to the abdomen. This can be safe and effective provided a careful protocol is followed. If a patient is a candidate for diagnostic abdominal laparoscopy (see previous section), then following steps are taken.


If a unilateral junction zone injury is present, then chest tube drainage is performed prior to surgery.


Diagnostic laparoscopy is performed with low pressure (10-12 mm Hg) under general anesthesia.


If no peritoneal or diaphgramatic wounds or abnormal fluid is detected, then internal injuries are considered absent and the laparoscopy was stopped.


If a defect of the peritoneum or diaphragm is found but no obvious signs of visceral injury, then carefully examine:

(1) supracolic compartment

(2) infracolic compartment

(3) pelvis

(4) entire length of the bowel intestines

(5) lesser sac


Methylene blue tinted normal saline was infused into the stomach via a nasogastric tube if gastric injury possible.


Injuries not followed by open laparotomy:

(1) nonbleeding injuries of spleen or liver

(2) nonbleeding omental injuries

(3) mesenteric hematoma


Open laparotomy was performed for:

(1) hole in bowel

(2) actively bleeding blood vessels

(3) foreign material (clothing, bullet, etc) seen

(4) enteric fluid seen

(5) bleeding without obvious source


If the patient had a normal postoperative course, then it is assumed that no significant injuries are undetected. If the course deviates from the expected, then:

(1) other complications are excluded

(2) laparotomy is performed if rebleeding is suspected

(3) laparotomy is performed if no cause is found to explain the clinical status


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