Title : Role of Bedside Urgent Diagnostic Laparoscopy in Lactic Acidosis
Unexplained lactic acidosis (LA) in a critically ill patient often prompts investigations to rule out any reversible intra-abdominal cause. Equivocal results can lead to an emergency exploratory laparotomy (EEL) with subsequent high morbidity and mortality rates. Our objective was to determine the clinical impact of urgent diagnostic laparoscopy (UDL) for critically ill patients with LA.
Methods and Materials
We present a case series on 28 consecutive critically ill patients with LA who were referred to a single surgeon over a 16-year period. These patients went for UDL either at bedside or in theatre without prior computerised tomography (CT) scan. Intraoperative findings were analysed.
Eighteen patients underwent bedside UDL in the critical care setting and further 10 had UDL in theatre. Fourteen patients had normal diagnostic laparoscopy, (10 had LA secondary to low cardiac output states) whereas fourteen had positive UDL findings. Seven patients had features of mesenteric ischaemia; two had gangrenous gallbladder, two had hepatic ischaemia, one patient had acute pancreatitis, one had gangrenous uterus and one had gastric volvulus. Five patients went to have formal laparotomy, however, 23 patients (82.1%) were spared from EEL. UDL did not contribute to morbidity or mortality in these patients. Outcome were dependent on primary pathology.
UDL is an appropriate and useful investigation for unexplained LA in the critically ill and EEL can be avoided in most patients. We would recommend the use of UDL as a safe, feasible investigation in selected patients with an unexplained lactic acidosis.