Laparotomy, exploratory

Those with liver abscess may take up to 7 days before there will be decreases in pain and fever. In liver abscess, patients not responding by the fifth day may require aspiration of the abscesses or exploratory laparotomy. 

A 43-year-old male in the surgical ICU after exploratory laparotomy following a motor vehicle accident develops fever that is unresponsive to broad-spectrum antibacterial therapy (piperacillin-tazobactam 3.75 g every 6 hours, gentamicin 120 mg every 8 hours, and vancomycin 1 g every 12 hours). The patient has a central venous catheter and a Foley catheter. Blood cultures are negative at the time, but the patient has yeast growing in the sputum and urine. Laboratory studies reveal a white blood cell count of 11,300 cells/mm3 (11.3 x 109/L). 

Exploratory laparotomy Surgical incision into the abdominal cavity, performed to examine the abdominal organs and cavity in search of an abnormality and diagnosis. 

The most disturbing adverse reaction to clofazimine is a red-brown discoloration of the skin, especially in light-skinned persons. A rare but serious adverse reaction is acute abdominal pain significant enough to warrant exploratory laparotomy or laparoscopy. Other infrequent side effects include splenic infarction, bowel obstruction, paralytic ileus, and upper GI bleeding. 

The arguments put forward by G. Kelling (1923) apply just as much today as they did in the past - exploratory laparoscopy of the abdominal cavity is one of the most important aims of laparoscopy. (246) (s. tab. 7.12) In working towards a diagnosis, it is a fundamental principle that exploratory laparoscopy should be given priority over exploratory laparotomy. (197, 205, 213, 215, 218, 227, 245, 253, 254, 277, 293, 294, 315)... 

With considerably less inconvenience to the patient, exploratory laparoscopy offers a better view of the minor pelvis through to the subphrenic space than can be provided by exploratory laparotomy with the limitations imposed by incision. Adhesions can also be viewed better with the help of laparoscopy as compared to laparotomy. 

Time and personnel involved as well as the costs of nursing are all far lower with exploratory laparoscopy than with laparotomy. In the vast majority of cases, exploratory laparoscopy renders exploratory laparotomy superfluous. Above all, this is true for the detection of nonoperable carcinomas. 

Mortality risk is given as being about 0.1% (-0.2%) for exploratory laparoscopy, whereas exploratory laparotomy has a lethality rate of about 2.5% - i.e. about 20 times higher In advanced carcinomas, the lethality rate is as high as 50% for exploratory laparotomy versus 7.4% for laparoscopy. 

A 20-year-old woman with unexplained hypoglycemia had an exploratory laparotomy with pancreatic biopsy, which showed a histological picture compatible with hyperplasia (36). Glipizide was detected in the blood at a concentration of 0.72 (usual target... 

Two women were investigated for cramping abdominal pain and bloody diarrhea (22). In only one did the episodes completely disappear after withdrawal of sumatriptan. The other underwent an exploratory laparotomy and right hemicolectomy for transmural bowel necrosis. 

Follow-up in patients with amebiasis should include repeat stool examination, serology, colonoscopy (in colitis), or computed tomography (CT in liver abscess) between days 5 and 7, at the end of the course of therapy, and a month after the end of therapy. Most patients with either intestinal amebiasis or colitis will respond in 3 to 5 days with amelioration of symptoms. Patients with liver abscesses may take from 7 to 10 days to respond patients notresponding during this period may require aspiration of abscesses or exploratory laparotomy. Serial liver scans have demonstrated healing of liver abscesses over 4 to 8 months after adequate therapy. ... 

The approach to diagnosing an adnexal mass discovered on pelvic examination depends on several factors, including the patient s reproductive age, adnexal mass size, menopausal status, and symptoms. Exploratory laparotomy is indicated in premenarchal women, women with masses greater than 8 cm, women with masses that increase or persist through several menstrual cycles or that are fixed to peritoneal surfaces, women with bilateral masses, or women with intra-abdominal pain or ascites. ... 

The client is scheduled for an exploratory laparotomy in the morning. Which order has priority ... 

A 32-year old man undergoing exploratory laparotomy was given erythromycin 1 g and neomycin 1 g, both three times daily, on the day before surgery. During the induction and maintenance of anaesthesia he received a total of 20.9 mg of alfentanil. An hour after recovery he was found to be unrousable and with a respiratory rate of only 5 breaths per minute. He was successfully treated with naloxone. Another patient given alfentanil and erythromycin is said to have developed respiratory arrest during recovery. ... 

Fig. 9.15. Torsion of a paraovarian cyst. In a 14-year-old girl with severe acute pelvic pain a cystic lesion was found on sonography. CT shows normal ovaries in the ovarian fossa and a 7-cm cystic lesion (asterisk) in the cul-de-sac. The latter shows mild wall thickening at its left contour. Exploratory laparotomy found torsion of a right paraovarian cyst with involvement of the right fallopian tube. The ovaries were unremarkable...

Penetrating duodenal injury occurs in areas with a high incidence of civilian violence. Due to the anatomic location of the duodenum and the close relation to adjacent vital viscera and vascular structures, isolated penetrating duodenal trauma is rare and is often diagnosed during exploratory laparotomy performed for the evaluation of associated injuries (Degiannis and Boffard 2000). 

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