Role of Laparoscopy in uncertain diagnosis of right lower abdominal pain

Abstract

Aim: Aim of the study was to evaluate role of laparoscopy for diagnosis and management of patients with pain in right lower abdomen with uncertain diagnosis. Material and Methods: A prospective study was carried out on 36 patients with right lower abdominal pain who had uncertain clinical diagnosis, whose diagnosis was not established by clinical examination and laboratory investigations at Lata Mangeshkar Hospital, Digdoh Hills, Hingna Road, Nagpur for a period of one year. Results: Total 36 patients were subjected for diagnostic laparoscopy out of which 25 were females and 11 were males. Mean age of presentation was 31.52 years. Out of 36 patients, 27 patients have appendicitis, 2 patients have appendicitis and right ovarian cyst, 1 patient have only right ovarian cyst, 2 patients have pelvic inflammatory disease and in 4 patients no abnormality detected. Appendicitis was found on laparoscopy in 29 patients with 93.1% diagnostic accuracy. In our study, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of laparoscopy in acute appendicitis comes out to be 100%, 66.6%, 96.2%, 100% and 93.1% respectively. Out of36 patients, the sensitivity of Alvarado score comes out to be 46.1 %, specificity 90 %, positive predictive value 92.3 %, negative predictive value39.1 % and diagnostic accuracy 58.3%. Negative appendicectomy was avoided in one male patient out of 11 patients (9.09%) and six female patients out of 25 female patients (24%). The use of laparoscopy as diagnostic tool can cut down unnecessary appendectomies especially in females. In our study, total seven (19.44%) negative appendectomies were avoided. Laparoscopy can detect pelvic inflammatory disease, ovarian cyst in patients of uncertain diagnosis of right lower abdominal pain. Conclusion: Laparoscopy has definite role in evaluation of pain in right lower abdomen with uncertain diagnosis. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value are more than Alvarado score in detecting acute appendicitis. It is useful especially in female patients to diagnose pelvic disease and rule out other pathology. With the help of laparoscopy therapeutic intervention can also be done at the same time with its advantages over open appendicectomy. We can reduce the no of negative appendectomies. Diagnostic laparoscopy can also be therapeutic with its advantages.