Rethinavelu, C (2016) One year prospective study on accuracy of diagnostic peritoneal paracentesis in acute abdominal condition requiring emergency surgical intervention. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
OBJECTIVE: Acute Abdomen is common in surgical practice. Most of the cases of acute abdomen can be diagnosed clinically in presence of abdominal pain, abdominal tenderness, guarding and rigidity. There should be certain diagnostic modality, which confirms the diagnosis and the surgeon should feel safe and accurate in deciding which patient, requires surgical intervention. Although imaging modalities like Xray, USG, CT, MRI etc.available and can diagnose near accurately, these investigations are not available everywhere or not available for 24 hours in developing countries like India. Therefore we need a diagnostic modality, which is simple, near accurate and easily available by the bedside. Abdominal Paracentesis is a simple bedside procedure, which is quite accurate in diagnosing acute abdominal conditions and helps in decision making whether surgical intervention needed or not. The present study will be undertaken to know the accuracy of Abdominal Paracentesis in surgical acute abdomen. MATERIALS AND METHODS: Fifty patients were examined by abdominal tap who presented as acute abdominal emergencies including postoperative and traumatic cases. The standard technique followed throughout this series was a four quadrant tap. A 10 ml syringe fitted with a 20 guage intravenous needle was used. Results were indicated as positive when > 0.5ml fluid or peritoneal aspirate was obviously pathological. Negative/dry tap, when no fluid is aspirated from all four quadrant. The aspirated peritoneal fluid was analysed both macroscopically in terms of nature, colour and odour of the fluid and microscopically for total WBC and RBC count. Microscopic findings of WBC > 500 cells/cu.mm or/and RBC >1 lakh cells/cu.mm was obviously pathological and considered as positive tap. WBC < 100cells/cu.mm or/and RBC <50,000Cells/cu.mm considered as negative tap and managed non operatively depending upon circumstances. INCLUSION CRITERIA : All patients aged above 12 years, with acute abdominal pain, both traumatic and non-traumatic conditions who require emergency surgical intervention will be included. EXCLUSION CRITERIA : All patients with the following diagnosis will be exclude from the study. 1. All pregnant patients. 2. All patients suspected of acute intestinal obstruction. 3. All patients with acute gastritis, acute non perforative biliary tract diseases, acute appendicitis. 4. All patients with renal or ureteric calculi. 5. All patients with extensive abdominal scar. RESULTS: 46 out of 50 cases tap was positive. Of these, 45 taps were true positive and were subjected to laparotomy and findings confirmed, in 1 case tap was found to be false fositive, which we managed conservatively. Of 4 negative/dry taps, 1 is true negative and 4 were false negative. The overall diagnostic accuracy in our study was 93.75%. In blunt trauma abdomen diagnostic accuracy was 100%, whereas in non-traumatic acute surgical abdomen, diagnostic accuracy was 91.42%. CONCLUSION: Abdominal paracentesis is a safe, accurate and reliable diagnostic procedure very useful in acute abdominal condition.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Laparotomy, abdominal paracentesis, acute abdomen, blunt trauma abdomen. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Oct 2017 01:00 |
| Last Modified: | 12 Oct 2017 01:00 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3546 |
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