Early management of abdominal trauma: the role of diagnostic peritoneal lavage.
This report reviews the contemporary value of diagnostic peritoneal lavage (DPL) in the assessment of abdominal trauma, and reports the methods and results of its application within one trauma centre (Washington Hospital Center). DPL was reserved for those patients where doubt existed as to the presence of intra-abdominal injury, and gave a very accurate assessment of intraperitoneal injury. The complication rate was 0.4% and the accuracy of DPL was 97.7%. Except for laparotomy, DPL is the most sensitive indicator of haemoperitoneum available. It was first introduced with the aim of reducing the number of missed diagnoses of abdominal injury and it performs this task excellently when a low threshold for positivity is used. The open technique is safest and gives fewer false positive results, and the colorimetric method of analysis of lavage fluid is recommended, with strict adherence to advised criteria for negativity. A clinical algorithm is described, utilizing DPL, aimed at early diagnosis of all intra-abdominal injuries. This was extremely sensitive and failed in only one case in 384 (0.3%). The attendant, non-therapeutic laparotomy rate was 19%, and is regarded as acceptable within the aims of early diagnosis. In this series, there was no mortality or morbidity attached to the use of DPL or from non-therapeutic laparotomy, and there was only one delayed diagnosis in the entire series. No bowel, bladder, diaphragmatic, duodenal or pancreatic injuries were missed or diagnosed late.
Danne
P D
PD
Trauma Service, Washington Hospital Center, DC.
Piasio
M
M
Champion
H R
HR
D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D000465:Algorithms; D006801:Humans; D007813:Laparotomy; D010533:Peritoneal Lavage; D011237:Predictive Value of Tests; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D014951:Wounds, Stab / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*