Diagnostic laparoscopy to investigate unexplained lactic acidosis in critically ill patients - A descriptive single centre cohort study.

Authors:
Mr Zulfiqar Hanif, FRCS,FCPS, Dip.Clin.Edu
Mr Zulfiqar Hanif, FRCS,FCPS, Dip.Clin.Edu
Hairmyres Hospital
Consultant Surgeon
Surgical Oncology
Glasgow, Scotland | United Kingdom

Ann Med Surg (Lond) 2018 Dec 13;36:231-234. Epub 2018 Nov 13.

Department of Surgery, University Hospital Hairmyres, NHS Lanarkshire, East Kilbride, G75 8RG, Scotland, UK.

Introduction: Unexplained lactic acidosis (LA) in a critically ill patient often prompts investigations to rule out any reversible intra-abdominal cause. Equivocal results can lead to an emergency laparotomy (EL) with subsequent high morbidity and mortality rates. Our objective was to determine the clinical impact of urgent diagnostic laparoscopy (UDL) in such patients.

Methods: This was a descriptive single-centre cohort study. UDL on 28 consecutive critically ill patients with unexplained LA who were referred to a single surgeon over 16 years period were analysed. UDL was proformed either at bedside or in theatre without prior computerised tomography (CT) scan. Patient's demographics, ASA grade, referral route and intraoperative findings were analysed.

Results: Eighteen patients underwent bedside UDL in the critical care setting and further 10 had UDL in theatre. Fourteen patients had normal UDL, out of these 10 had LA secondary to low cardiac output states. Fourteen patients had positive UDL findings. Seven patients had features of mesenteric ischaemia, two had gangrenous gallbladder, two had hepatic ischaemia, one patient had acute pancreatitis, one had gangrenous uterus and one had gastric volvulus. Five of the 14 patients with positive UDL were converted to laparotomy for definitive management. In total, of the 28 patients in the cohort, 23 patients avoided EL.

Conclusion: UDL is useful and feasible investigation for unexplained LA in the critically ill patients and it can avoid unnecessary EL in many patients. We would recommend the use of UDL as a safe and feasible investigation in such patients.

Download full-text PDF

Source
https://linkinghub.elsevier.com/retrieve/pii/S20490801183025
Publisher Site
http://dx.doi.org/10.1016/j.amsu.2018.11.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260236PMC
December 2018
31 Reads

Publication Analysis

Top Keywords

critically ill
16
ill patients
12
patients
12
udl
10
patients positive
8
fourteen patients
8
diagnostic laparoscopy
8
lactic acidosis
8
feasible investigation
8
acidosis critically
8
positive udl
8
unexplained lactic
8
cohort study
8
converted laparotomy
4
theatre prior
4
tomography scan
4
computerised tomography
4
volvulus patients
4
udl converted
4
prior computerised
4

Similar Publications