Clinical uses of diagnostic peritoneal lavage in stab wounds of the anterior abdomen: a prospective study.
OBJECTIVE
To evaluate patients with stab wounds of the anterior abdomen with diagnostic peritoneal lavage (DPL), by using initial aspiration of gross blood from the lavage catheter of more than 10 ml or red blood cell (RBC) count in the lavage fluid of more than 10,000/mm3 as criteria for exploratory laparotomy.


METHODS
Prospective study.


METHODS
University hospital, Thailand.


METHODS
40 patients who had stab wounds of the anterior abdomen penetrating through the peritoneum but had no obvious indications for immediate exploratory laparotomy.


METHODS
Diagnostic peritoneal lavage (DPL), exploratory laparotomy.


METHODS
Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of positive DPL as an indication for exploratory laparotomy.


RESULTS
In 27 patients (68%) the DPL was positive and in 13 (33%) it was negative. In 18 patients (67%) the initial aspiration of gross blood was more than 10 ml and in 9 (33%) the RBC count in lavage fluid was more than 10,000/mm3. These 27 patients had exploratory laparotomies, 2 of which were negative. All 13 patients who had negative DPL were observed and discharged home uneventfully. The sensitivity of DPL for positive laparotomy was 100%, the specificity was 87%, the PPV was 93%, the NPV was 100% and the accuracy was 95%. When operative findings of bleeding from the stab wound into the peritoneal cavity were considered as a "negative" laparotomy (n = 7) the sensitivity, the specificity, the PPV, the NPV and the accuracy became 100%, 59%, 67%, 100%, and 78%, respectively.


CONCLUSIONS
The use of DPL in patients with stab wounds of the anterior abdomen, using initial aspiration of gross blood from the lavage catheter of more than 10 ml or RBC count in the lavage fluid of more than 10,000/mm3 as positive criteria for exploratory laparotomy, is safe and practical.
Sriussadaporn
Suvit
S
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Pak-art
Rattaplee
R
Pattaratiwanon
Mongkol
M
Phadungwidthayakorn
Arruk
A
Wongwiwatseree
Yongsun
Y
Labchitkusol
Taveesak
T
D000007:Abdominal Injuries / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D004906:Erythrocyte Count; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014951:Wounds, Stab / Q000175:diagnosis*