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THE USE OF LAPAROSCOPY IN THE DIAGNOSIS AND TREATMENT OF PENETRATING TRAUMA Igor Sheikis, Eitan Ben-Zion, Moshe Zilberman, Adiv Nickola, Nissim Gero. Department of Surgery, Poria Hospital

The use of laparoscopy was expended lately to include cases of abdominal trauma. Many recently published series found laparoscopy to be an efficient means for diagnosis and in some cases an adequate means for treatment. We would like to present the clinical experience the department of surgery in Poria hospital had with the use of laparoscopy in the diagnosis and treatment of three cases of penetrating abdominal trauma. Case #1: A 52 years old woman with an upper abdominal gunshot wound was admitted to the emergency room. She was found to be hemodynamically stable. Physical examination revealed two gunshot wounds in the right arm, two in the right breast, and one in middle of the upper abdomen. A bullet was palpated subcutaneously in the left flank. FAST demonstrated a small amount of fluid around the liver. Abdominal CT demonstrated fat stranding and several small air bubbles anterior to the stomach along a possible bullet path. Laparoscopy was performed and revealed a penetrating wound in the upper abdomen, an entry and an exit wound in the margins of the left lobe of the liver, and an entry and an exit wound in the stomach. A minimal amount of bloody fluid around the liver was also found. The wounds found in the stomach were sutured. There were no intra or post-operative complications. Case # 2: A 41 years old man with stab wounds caused by a knife on the right and on the left of the posterior chest was admitted to the emergency room. He was found to be hemodynamically stable. Imaging studies that included chest x-ray, US-FAST and CT scan of the chest and abdomen were performed. The studies demonstrated pneumothorax, rupture of the spleen in its middle part, a small amount of free fluid in the upper abdomen and in the pelvis. Free air was not demonstrated in the abdominal cavity. Bilateral intercostal drains were inserted, and he was admitted to the intensive care unit. A chest x-ray, which was performed a few days later, was suggestive of a rupture of the diaphragm. A CT scan performed consolidated the suspicion and demonstrated fat transversing the diaphragmatic rupture. Laparoscopy was performed and revealed two diaphragmatic ruptures containing omentum. The diaphragm was repaired by suturing. There were no intra or post-operative complications. Case # 3: An 18 years old soldier was injured when he was assaulted with a knife. He had pain in the epigastrium and physical examination revealed tenderness in the upper abdomen. He was admitted to the emergency room and was found to be conscious and hemodynamically stable. A chest x-ray performed was normal. FAST demonstrated no pericardial effusion and a small amount of free fluid in the abdomen. Laparoscopy was performed and revealed a penetrating right upper abdominal wound, a cut in the left lobe of the liver, and a cut in the anterior gastric wall. The gastric cut was sutured. There were no intra or post-operative complications. Conclusion In special instances of penetrating abdominal trauma, when the patient is hemodynamically stable, laparoscopy can be successfully used for diagnosis 0008 ENDO and for treatment. In such instances laparoscopy is a useful and a safe means, and can replace laparotomy with it’s accompanying drawbacks.