Peritoneal lavage and the surgical resident.
Peritoneal lavages performed in 161 patients who had sustained blunt (93 per cent) and penetrating (7 per cent) trauma were prospectively studied in order to assess our indications and technique, as well as to document the accuracy and complication rate in the hands of an Advanced Trauma Life Support trained resident staff. The most common indication for the performance of a lavage was blunt trauma to the abdomen associated with an altered mental status due to injury to the head or substance abuse. The semiopen technique was used 91.0 per cent of the time with a complication rate of 0.6 per cent. The open technique was used 9 per cent of the time on patients who had undergone previous limited abdominal operations, those who were pregnant, those with dilated intestine and for those patients with evidence of portal hypertension. Aspiration of greater than 10 milliliters of gross blood, an erythrocyte count greater than 100,000 per millimeter to the third power, or a white blood cell count greater than 500 per millimeter to the third power or an elevated amylase or bilirubin level in the lavage effluent, were the criteria used for a positive result in blunt trauma. The accuracy rate was 93 per cent with eight false-positive and three false-negative examinations. The sensitivity rate was 94 per cent and the specificity rate was 93 per cent. While most reported series classify lavage results as true-positive when intraperitoneal blood is found at exploration, even if secondary to trivial injuries which do not require surgical therapy (nontherapeutic laparotomy), we believe that these should be classified as false-positive results, as was done in this study. Computerized tomographic scanning may be more useful than peritoneal lavage in the evaluation of patients with pelvic fractures or other retroperitoneal injuries which often result in false-positive lavage. Peritoneal lavage is often an inaccurate indicator of isolated intestine and diaphragmatic or retroperitoneal injury. Given its simplicity, low complication rate and accuracy, peritoneal lavage can be safely performed by surgeons in training to evaluate the victim of trauma.
Trauma Service, Massachusetts General Hospital, Boston 02114.
H L
HL
Walters
J
J
Hupp
C J
CJ
McCabe
J F
JF
Burke
D000007:Abdominal Injuries / Q000175:diagnosis; D001900:Boston; D004630:Emergencies; D004635:Emergency Medicine / Q000193:education; D005069:Evaluation Studies as Topic; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D007396:Internship and Residency; D010533:Peritoneal Lavage / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D014949:Wounds, Nonpenetrating / Q000175:diagnosis; D014950:Wounds, Penetrating / Q000175:diagnosis