الفهرس 
Contents
Causes and difficulties in Management of Acute AbdomenOnly 14 pages are availabe for public view
 |  | from | 106 |  |  |
| | | from | 106 | | |
Abstract
Abdominal causes of sepsis are associated with considerable high rates of morbidity and mortality in order to decrease these rates we should consider shortening time needed for diagnosis. Diagnosis of causes of sepsis in critically ill patients is challenging as clinical picture is not reliable as result of disturbed conscious level and deep sedation that may hide symptoms and signs and also laboratory investigations are not conclusive, when we proceed to radiological investigation we face many obstacles varying between the availability of radiological investigations, the availability of experienced hands, time consumed during the investigation and the risk of transport to the radiological department especially in critically ill patients. The results of radiology may not be accurate or conclusive. When we can’t reach to the source of infection by the available facility we can do early laparotomy when we suspect intra-abdominal cause of sepsis, on the other hand negative laparotomy associated with high rate of complications. For the previous information, here arises bedside laparoscopy as a minimally invasive procedure not carries risk of transport and can provide diagnosis of intra-abdominal causes of sepsis.To achieve this aim, 40 patients were included in this study: patients were divided into 2 groups ; group A 20 patient (10 male, 10 female) to them laparoscopy is done after admission immediately and group B 20 patient (13 male, 7 female) to them close follow up for 48 hours unless clear indication to laparotomy or systemic deterioration.During the procedure no deterioration on patient ABG due to pneumoperitoneum, only in 2 cases of 20 cases the procedure stopped due to concern of hemodynamic stability of the patient by anaesthia team but with no harm to the patients.Bedside laparoscopy show diagnostic accuracy 90% and it decrease rate of negative laparotomy in cases of its group and it show significant reduction in comparison with open group. In group )A( only 1 case represent 6.67% of 15 cases explored was negative, in group B 7 cases represent 38.9% of 18 cases explored were negative.As regard mortality, no mortality related to procedure and there was reduction on mortality in the group of bedside laparoscopy but there was no statistically significant difference between 2 groups, this explained by the high mortality among these patients due to multiple factors including associated co-morbidities, nature of the pathology and degree of SIRS so this may result in failure to survive even if pathology detected and managed appropriately.There was significant reduction in post-operative complications in bedside laparoscopy group. Wound related complications are high in group II of 18 cases explored 4 cases of wound infection, 2 cases of burst abdomen and 2 cases of intestinal injury Conclusion: Bedside laparoscopy should be applied on larger scale when non-invasive tools can’t reach for diagnosis of the cause of sepsis when the abdomen is suspected to be the source of sepsis because despite it is an invasive procedure it is considered safe minimally invasive with high diagnostic accuracy and result in marked reduction of the rate of negative laparotomy also it is associated with lower post-operative complications.