Diagnostic Laparoscopy in Blunt Abdominal Trauma: A Descriptive Study

Abstract

Background: The role of laparoscopy in blunt abdominal trauma remains controversial, particularly in resource limited settings where diagnostic challenges are magnified. While laparoscopy is well established in penetrating trauma, its utility in hemodynamically stable patients with blunt abdominal trauma is not clearly defined. This study aimed to evaluate the role of diagnostic and therapeutic laparoscopy in the management of blunt abdominal trauma.

Methods: This descriptive study was conducted in the Department of Surgery at Nishtar Medical University and Hospital, Multan, Pakistan, over a six-month period. Hemodynamically stable patients with blunt abdominal trauma who underwent laparoscopic exploration were included. Data regarding demographics, cause of injury, computed tomography findings, intraoperative findings, surgical procedures, conversion rates, complications, and length of hospital stay were recorded. Organ injuries were graded according to the American Association for the Surgery of Trauma classification. Statistical analysis was performed using SPSS version 24.

Results: A total of 37 patients (28 laparoscopic, 9 converted) were included. Mean age was 34 years, with female predominance (89.2%). Assault was the predominant mechanism in the laparoscopic group (60.7%), while traffic accidents prevailed in the converted group (77.8%). Preoperative CT was negative in 35.7% of laparoscopically managed patients; notably, 30% of these required therapeutic intervention for grade 2 mesenteric injuries. The converted group had significantly higher Penetrating Abdominal Trauma Index scores (p=0.008). Conversion rate was 24.3%, with bleeding and complex injuries being common reasons. Complications occurred in 24.3% of patients, including five grade 3 and four grade 5 events. All four deaths occurred in severely injured polytrauma patients.

Conclusion: Diagnostic laparoscopy is a feasible and safe approach in hemodynamically stable patients with blunt abdominal trauma. It enables accurate diagnosis and therapeutic intervention, particularly when CT findings are negative but clinical suspicion persists. Larger multicenter studies are required to refine patient selection criteria.