The Role Of Diagnostic Laparoscopy In Chronic Right Iliac Fossa Pain

Abstract

Aim: The aim of our study is to evaluate the role of diagnostic laparoscopy in patients with chronic right iliac fossa pain and document the correlation between laparoscopic and radiological findings. Methods: The study is a 2 year prospective observational study including cases presenting with chronic right iliac fossa pain in which a conclusive diagnosis can't be made on the basis of other investigations. All patients underwent diagnostic laparoscopy and the findings were documented. Laparoscopy is considered positive if there is a pathological finding present correlating to patient's symptoms and whether the patient got relieved after subsequent intervention or not. Result: There were total 40 patients, out of which 67.5% were females and 32.5 % were males. Most of the patients (55%) were in the age group of 15-25 years. Majority of the patients (67.5%) presented within 3 months to 6 months duration from the onset of their symptoms. Most of the patients (62.5%) had normal clinical examination. Ultrasonography abdomen had no evident findings in 30 % patients and in remaining 70 % patients the ultrasonography findings were not correlating with patient's symptoms. In this study we were able to make diagnosis in 92.5 % cases. We were able to diagnose 16 case of recurrent appendicitis (40%). There were 2 case of acute on chronic appendicitis (5%) and one case of Amyand's hernia (2.5%) with appendix as content of hernia sac. We were able to diagnose 5 cases (12.5%) of abdominal Koch's. In 10% cases, adhesions were cause of pain. We were able to diagnose 9 patients (22.5%) with gynaecological pathology as the cause of CRIF pain. In our study we were able to diagnose and avoid unnecessary laparotomies in 95 % of patients. Laparotomies were performed in only 2 cases (5%) for open adhesiolysis in which dense adhesions were present. The complications were reported in only 3 patients (7.5%). Overall 90% patients reported improvement of symptoms following intervention. Conclusion: Diagnostic laparoscopy should be performed in selected group of patients with CRIF pain with equivocal radiological diagnosis as an early investigative procedure. In a poor socio-economic country like us diagnostic laparoscopy should be promoted in place of costly radiological investigations as it can provide diagnosis and treatment at the same setting. Recurrent appendicitis is the most common cause of CRIF pain in young adults especially in females.