De Rungs-Brown DR, Víctor-Baldin A, Muñoz-Hinojosa J, Valdés-Castañeda A, Gómez-Palacio M, Pérez-Cantú SA

Language: Spanish
References: 21
Page: 18-23
PDF size: 201.40 Kb.

ABSTRACT

Introduction: The emergency diagnostic laparoscopy in acute abdomen has a great utility to confirm a clinical diagnosis. However the diagnosis of clinical suspicion does not always coincide with laparoscopic findings. Evidence-based medicine is very important in this stage correlating clinical diagnosed with surgical diagnosis in diagnostic laparoscopy. Material and methods: A meta-analysis comparison with eight databases was conducted for articles in the past 50 years: 90 items selected, then were tested for homogeneity of the data by using the test statistic Odds Breslow-Day ratio. Studies were combined and positive and negative predictive values were calculated by Cochran-Mantel-Haenszel. I will identify and compare the findings on physical examination according to the main signs identified in each of the pathologies described with the final diagnosis by diagnostic laparoscopy. Results:The four main causes of acute abdominal pain in the emergency department (n = 12,706) requiring diagnostic laparoscopies were appendicitis, cholecystitis, intestinal occlusion and chronic gastropathies. 9,478 patients with acute appendicitis were identified by 60% of diagnoses of acute abdomen, which most suggestive for laparoscopy clinical findings were abdominal pain and Von Blumberg sign PPV of 7.9 (7.3 to 8.5), McBurney point with a positive predictive value of 4.2 (1.1-6.3). 87% of patients with surgical diagnosis correlated in diagnostic laparoscopy. In 5,716 patients with acute cholecystitis in 20% of the diagnosis of acute abdomen. The positive Murphy sign with a PPV of 2.8 (0.8-8.6 and abdominal rigidity with a PPV of 1.6 (1.0-2.5) accounted for 95% of clinically correlated with laparoscopic exploration. In 2,375 patients attributed 10% of acute abdomen and 75% clinical and diagnostic laparoscopies correlation showed an active peristalsis VPP 9.5 (16.3 to 22.4) and abdominal distension with a PPV of 6.3 (09.03 to 12.03). The missing 10% of the diagnoses were emergency Patients with 3,134 patients presenting sign wave with a PPV 6 (3.3 to 11.0), palpation for splenomegaly with a PPV of 8.2 (5.8-12) and palpable hepatomegaly with a positive predictive value of 2 (1.5 -2.8) liver edge. Conclusion: The clinical correlation with findings in the diagnostic laparoscopy was 96.1 % PPV (1.1 to 3) having significance. The three main pathologies can have their presumptive diagnosis doing the proper clinical examination of the patient. Proving that evidence-based medicine and ritual importance of physical examination is the best diagnostic method correlating histopathological diagnosis and surgical trans- diagnosed by laparoscopic.

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