PubMed · 6020800
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T B Hubbard, R A Harris. 1967. Diagnostic laparotomy.. https://pubmed.ncbi.nlm.nih.gov/6020800/
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UNLABELLED: A 9-year-old boy lost almost all his small bowel after an acute volvulus due to a congenital, but previously unsuspected malrotation. Survival using total parenteral nutrition is possible in these cases, but the medical burden is heavy. Small intestinal transplantation was performed for the first time in the Netherlands in 2001 and this patient was treated 3 years earlier. The results of bowel transplantation are not as good as in kidney or liver transplantation. A method of Ethical Case Deliberation helped to elucidate the importance of each contribution in the discussion and provided space and a broad basis for decision-making. The parents refused to allow parenteral nutrition to be started because of the bad prospects for quality of life in the future and the medical team, after thorough deliberation with specialists throughout the country, and consultation of the literature, agreed. CONCLUSION: Despite the many different opinions, the parents felt accepted in their refusal of treatment for their son and the team accepted the decision.
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Diagnostic laparoscopy began in a surgical unit in a developing country in 1972. The developers of this technique aimed to hasten diagnosis, reduce patient distress, and improve bed utilization in an overcrowded teaching hospital wherein simple investigations such as x-rays took weeks to materialize. Over a period of 18 years reaching to 1990, 3,200 diagnostic laparoscopies were performed on adults under local anesthesia with no mortality, a complication rate of 0.09%, an 84% diagnosis rate, and 74% undergoing histologic biopsies targeting a wide spectrum of pathology. The equipment cost spread out over the 3,200 patients works out to 30 rupees (0.60 dollar) per patient. With the availability of noninvasive diagnostic aids such as ultrasound, computed tomography, and magnetic resonance imaging used US, CT, MRI under the control of target biopsy, the role of diagnostic laparoscopy has altered. Since 1990, clinicians have had the sophistication of the video camera and the pneumoperitoneum insufflator. Diagnostic laparoscopy is used for the evaluation of liver and peritoneal pathology, abdominal tuberculosis, malignancy, acute abdomen, and abdominal trauma. It often is a prelude to laparoscopic treatment of the underlying pathology, specifically in cases of acute appendicitis.