Stan T Smith, MD, Cyrus A Kotwall, MD, Thomas V Clancy, MD, William W Hope, MD. New Hanover Regional Medical Center
The role of laparoscopy for trauma, both diagnostic and therapeutic, continues to evolve. The safety and efficacy of laparoscopy in select trauma patients has been well described but its use has often been relegated as a screening modality in patients with penetrating injuries. There have been few reports on the use of therapeutic laparoscopy in colonic injuries and its use remains controversial.
We present a case of a 28 year old male who presented to the emergency room with multiple superficial stab wounds to the neck, chest, and abdomen. The patient was hemodynamically stable without peritonitis. The patient underwent computed tomography evaluation where there was no evidence of peritoneal penetration or free intraperitoneal air related to the left lateral abdominal stab wound. The patient was admitted and observed with serial abdominal exams. Approximately 12 hours after admission the patient’s abdominal pain worsened which prompted a diagnostic laparoscopic exam. Findings at laparoscopy showed a small sigmoid colon injury that was repaired laparoscopically. The patient had an uneventful postoperative course and was discharged home on postoperative day 4.
Therapeutic laparoscopy in selected trauma patients may represent a minimally invasive alternative to exploratory laparotomy. In this video we review the pertinent literature and operative techniques for therapeutic laparoscopy in trauma colonic injuries.
Program Number: V094