Contributions of peritoneal lavage enzyme determinations to the management of isolated hollow visceral abdominal injuries.
OBJECTIVE
To determine the role of lavage amylase (LAM) and lavage alkaline phosphatase (LAP) in the identification of intraperitoneal hollow visceral injuries.


METHODS
Retrospective.


METHODS
Level I trauma center, city/county institution.


METHODS
Patients with hollow visceral organ injury following major blunt or penetrating trauma whose diagnostic peritoneal lavage was negative by lavage red blood cell and lavage white blood cell were negative.


RESULTS
Fifty-one patients with injury isolated to one or more hollow visceral structures underwent diagnostic peritoneal lavage; 28 were positive based on aspirate, lavage red blood cell count (greater than 100,000/mm3), or lavage white blood cell count (greater than 500/mm3). Of the remaining 23 patients, each of 11 with isolated small bowel injury had LAM greater than or equal to 20 IU/L and six of these had LAP levels greater than or equal to 3 IU/L. All six patients with colon injury and two of the patients with gallbladder injury had LAM less than 20 IU/L and LAP less than 3 IU/L.


CONCLUSIONS
In patients with hollow visceral injury and otherwise normal diagnostic peritoneal lavage, elevation in LAM is highly specific for isolated small bowel injury. Lavage enzyme determinations appear unhelpful in the detection of colonic injury. We recommend routine enzyme determinations of lavage effluent as a marker for isolated small bowel injury.
McAnena
O J
OJ
Department of Emergency Medical Services, Denver General Hospital, Colorado 80204-4507.
Marx
J A
JA
Moore
E E
EE
D000007:Abdominal Injuries / Q000175:diagnosis*; D000328:Adult; D000469:Alkaline Phosphatase / Q000032:analysis*; D000681:Amylases / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D004906:Erythrocyte Count; D005260:Female; D006801:Humans; D007422:Intestines / Q000293:injuries; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*; D014950:Wounds, Penetrating / Q000175:diagnosis*
D000469:Alkaline Phosphatase; D000681:Amylases