Is positive diagnostic peritoneal lavage an absolute indication for laparotomy in all patients with blunt trauma? The Montreal General Hospital experience.
The authors review the use of diagnostic peritoneal lavage (DPL) at The Montreal General Hospital between 1982 and 1987. Fifty-two of 254 patients admitted with a diagnosis of blunt abdominal trauma underwent DPL: results of the procedure were negative in 23 and positive in 29 (grossly positive in 27). Twenty-one of the 23 patients with negative findings were managed nonoperatively; the other 2 underwent laparotomy, which revealed no abnormalities. Nineteen of the 29 patients with positive findings were managed by immediate laparotomy; the other 10 were managed conservatively. The mean (+/- standard deviation) injury severity score (ISS) in the latter group was 13.1 +/- 8.01. The group managed by immediate laparotomy had an ISS of 25.91 +/- 12.81 (p = 0.007). The number of patients suffering from class I or class II shock in the group managed nonoperatively was significantly (p = 0.045) larger than those in the group managed by laparotomy. The authors conclude that a positive result DPL is not a sine qua non for immediate laparotomy in all patients with blunt abdominal trauma. A selective approach can be taken in these patients, considering the severity of the associated injuries and the patient's hemodynamic status. Intensive-care monitoring must be available.
Barba
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C
Department of Surgery, Montreal General Hospital, McGill University, Que.
Owen
D
D
Fleiszer
D
D
Brown
R A
RA
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D001769:Blood; D005260:Female; D006769:Hospitals, General; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy; D008297:Male; D010533:Peritoneal Lavage; D012771:Shock, Hemorrhagic; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000601:surgery