title: Is positive diagnostic peritoneal lavage an absolute indication for laparotomy in all patients with blunt trauma? The Montreal General Hospital experience.
abstract: 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.
authors.affiliation: Department of Surgery, Montreal General Hospital, McGill University, Que.
authors.forename: C
authors.initials: C
authors.lastname: Barba
authors.forename: D
authors.initials: D
authors.lastname: Owen
authors.forename: D
authors.initials: D
authors.lastname: Fleiszer
authors.forename: R A
authors.initials: RA
authors.lastname: Brown
mesh_terms: 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