The inadequacy of peritoneal lavage in diagnosing acute diaphragmatic rupture.
Thirty-eight patients with acute diaphragmatic rupture secondary to blunt trauma have been reviewed. Peritoneal lavage is diagnostically inexact in patients with diaphragmatic rupture. One-fourth of the patients had falsely negative peritoneal lavages during their initial evaluation. All four patients without associated intra-abdominal injuries had falsely negative peritoneal lavages, as did four of 30 patients (13%) with significantly associated intra-abdominal injuries. We conclude from these data that: 1) peritoneal lavage is falsely negative in patients with isolated diaphragmatic rupture; 2) positive peritoneal lavage in patients with diaphragmatic rupture results from associated intra-abdominal injuries; and 3) peritoneal lavage may be falsely negative despite significant intra-abdominal injuries; because of herniation of injured organ(s) into the thoracic cavity, thus bleeding is excluded from the peritoneal cavity.
D000007:Abdominal Injuries / Q000175:diagnosis; D000063:Accidents, Traffic; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005188:False Negative Reactions; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis; D006549:Hernia, Diaphragmatic, Traumatic / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D013903:Thoracic Surgery; D013909:Thorax / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000150:complications