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Laparoscopy, which has been well known as a diagnostic procedure for more than a century, has recently established itself as an important therapeutic procedure in several branches of surgery. In the present study the authors report on 221 patients over a 10-year period (1991-2001), admitted to hospital with a diagnosis of acute abdomen or abdominal trauma. All patients were submitted to emergency laparoscopic surgery; 128 patients (57%) presented acute appendicitis, 40 (18%) acute cholecystitis, 13 (6%) occlusive ileus, 10 (5%) adnexal pathologies, 9 (4%) perforation of abdominal viscera, 3 (1.4%) acute diverticulitis, 3 (1.4%) subdiaphragmatic abscesses, 3 (1.4%) intestinal infarction, 2 (0.8%) other diseases and 10 (5%) abdominal trauma. The operation was completed laparoscopically in 192 cases (87%), while conversion to laparotomy proved necessary in 29 cases (13%). The morbidity of the cases completed laparoscopically was 3%, the mortality 0.5%, and the mean hospital stay 4 days. Advantages of laparoscopy (shorter hospital stay, rapid postoperative recovery and faster return to social activities) emerge from the present study and are confirmed by the literature. The possibility of combining a diagnostic procedure with curative therapy suggests that laparoscopy may have an important role in emergency surgery, demonstrating its efficacy also in acute abdominal syndromes. Nevertheless, emergency laparoscopic surgery is still a technically difficult procedure that needs to be performed by an expert surgical team.

The Authors report a case of abdominal traumatism by gunshot wound, presenting with retroperitoneal hematoma and hematoma of the mesocolon, treated in emergency laparoscopy. After a literature review and their case report analysis, they confirm the importance of emergency laparoscopy in hemodynamically stable patients, as well as the diagnostic value of peritoneal lavage, positive for minimal and moderate hemoperitoneum. Laparoscopy allows, as the same time in most cases, the diagnosis and the management of the lesion, while surgery is reserved to the cases of severe hemoperitoneum and perforating injuries. The use of laparoscopy in abdominal blunt injuries, has reduced the number of unnecessary laparotomies with related higher incidence of morbidity. The Authors conclude confirming the importance of this technique for its diagnostic efficacy, lower costs, minimal traumatism, and good aesthetic results as observed in the case report for the modality of the injuries, the young age and the previous sternotomy of the patient.