Rahman Md Sumon, Banna Hasan Ul, Hasan Md Nazmul, Jumman Mohammad
Department of Surgery, Dhaka Community Medical College Hospital, Dhaka, Bangladesh.
Department of Surgery, Ibn Sina Medical College Hospital, Dhaka, Bangladesh.
Int J Surg Case Rep. 2020;72:285-289. doi: 10.1016/j.ijscr.2020.05.089. Epub 2020 Jun 12.
Acute peritonitis is a surgical emergency and is conventionally managed with exploratory laparotomy in many centers, but laparoscopy is not contraindicated in such conditions. Operative management remains a cornerstone treatment in peritonitis irrespective of the primary pathology.
A 32-years-old man was admitted with acute diffuse peritonitis. As he was clinically stable, we proceeded with conservative treatment and diagnostic workup. He did not respond by 24 h and CT imaging showed ascites, but no definite diagnosis could be made. Diagnostic laparoscopy was performed, thorough peritoneal toileting was done but surprisingly the etiology was unclear. Following laparoscopy, he responded well with an uneventful recovery.
Timely proper evaluation and correct intervention are a paramount concern for the positive outcome. Regarding the most effective operative approach (laparotomy or laparoscopy) in acute peritonitis remains controversial in the literature and laparoscopy has been considered as a relative contraindication. However, the laparoscopy is gaining wider acceptance as the limitations of laparoscopy are declining rapidly. We experienced a case of extensive peritonitis with unclear etiology which we managed successfully by laparoscopy.
Laparoscopic approach in peritonitis is effective and helpful for accurate diagnosis and to minimize the hazards of an unnecessary laparotomy. This case report might encourage many surgeons to consider laparoscopic approach in peritonitis with confidence and to perform further studies.
急性腹膜炎是一种外科急症，在许多中心传统上采用剖腹探查术进行治疗，但在这种情况下腹腔镜检查并非禁忌。无论原发性病理如何，手术治疗仍然是腹膜炎的基石性治疗方法。
一名32岁男性因急性弥漫性腹膜炎入院。由于他临床情况稳定，我们进行了保守治疗和诊断性检查。24小时后他没有反应，CT成像显示有腹水，但无法明确诊断。进行了诊断性腹腔镜检查，彻底清理了腹腔，但令人惊讶的是病因仍不清楚。腹腔镜检查后，他恢复良好，康复过程顺利。
及时进行恰当评估和正确干预是取得良好预后的首要关注点。关于急性腹膜炎最有效的手术方式（剖腹手术或腹腔镜手术）在文献中仍存在争议，腹腔镜检查一直被视为相对禁忌。然而，随着腹腔镜检查局限性的迅速减少，其正获得更广泛的认可。我们遇到一例病因不明的广泛腹膜炎病例，通过腹腔镜检查成功进行了处理。
腹腔镜治疗腹膜炎对准确诊断和减少不必要剖腹手术的风险是有效且有帮助的。本病例报告可能会鼓励许多外科医生自信地考虑在腹膜炎治疗中采用腹腔镜方法并开展进一步研究。
