Elsevier

Injury

Volume 31, Issue 7, 1 September 2000, Pages 479-482
Injury

Experience with over 2500 diagnostic peritoneal lavages☆

https://doi.org/10.1016/S0020-1383(00)00010-3Get rights and content

Abstract

This study was undertaken to confirm the safety and efficacy of diagnostic peritoneal lavage (DPL) for trauma patients. A prospectively maintained database of all DPLs performed in the past 75 months was analyzed. A red blood cell count of 100,000/mm3 was considered positive for injury in blunt trauma; 10,000/mm3 was considered positive for peritoneal penetration in penetrating trauma. Information relative to type of injury, DPL result, laparotomy result and complications, was analysed to determine if DPL was more or less suited to any specific indication or type of patient. Over a 75 month period, 2501 DPLs were performed at our urban level I trauma center. The overall sensitivity, specificity and accuracy for the above thresholds were 95, 99 and 98%. The majority (2409, 96%) were performed using percutaneous or “closed” seldinger technique. Ninety-two (4%) were performed using open technique because of pelvic fractures, previous scars and pregnancy. Open DPL was less sensitive than closed DPL in patients who sustained blunt trauma (90 vs 95%) but slightly more sensitive in determining penetration (100 vs 96%). Overall, there were 21 complications (0.8%). There was no difference in complication rate between open and closed DPL. In conclusion, DPL remains a highly accurate, sensitive and specific test with an extremely low complication rate. It can be performed either open or closed with comparable results. We recommend its use in the evaluation of both blunt and penetrating trauma.

Introduction

Since the initial description of Diagnostic Peritioneal Lavage (DPL) in 1965 [1], this test has become a mainstay in the diagnosis of abdominal trauma. Several modifications of the original technique and interpretation have occurred during subsequent years resulting in our current use of this test. We present our prospectively gathered experience with this diagnostic test in order to reaffirm its continued application as a safe and accurate test in both blunt and penetrating trauma.

Section snippets

Materials and methods

At our urban level I trauma center, all patients who sustain suspected abdominal trauma who have no obvious indications for laparotomy and who we feel have an unreliable or equivocal abdominal examination undergo diagnostic peritoneal lavage (DPL). DPL is preferentially performed as a percutaneous Seldinger technique (closed DPL) after placement of a foley catheter and a nasogastric tube. If the patient is obese and the 2-1/2 in. introducer needle will not penetrate the abdominal wall a

Results

Between 1 August 1992 and 1 November 1998, 2501 DPL's in adult patients were performed by our service. There were 2162 (86.4%) males and 339 (13.6%) females with an average age of 30.4±12.5 years (range=12–88 years). The majority of DPLs, 2380, were performed using a Seldinger technique.Twenty-nine patients were obese and required a semi-open technique. These 2409 patients (96%) are considered together because both techniques involve a blind entry into the peritoneal cavity. The remaining 92

Discussion

The diagnostic peritoneal lavage was first described in 1965 by Root et al. [1] who described a method for sampling the peritoneal cavity to determine more rapidly the presence of hemoperitoneum after trauma. Since initial physical examination can be misleading in up to 45% of blunt trauma patients, DPL can be useful in diagnosing abdominal injury in a timely fashion [3]. It is especially useful when the abdominal examination is unreliable [4], [5] due to a change in the patient’s sensorium, or

Conclusions

In summary, we feel that the DPL continues to be a useful test in the evaluation of all types of abdominal trauma. Seldinger technique, or closed DPL can be used in the majority of patients, with use of semi-open or open techniques as indicated. The threshold RBC count can be adjusted from 100,000 RBC/mm3 in patients who have sustained blunt trauma or an anterior abdominal stab wound, to a lower 10,000 RBC/mm3 in patients who may have suffered penetration of the abdominal cavity. Both counts

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    • Cited by (0)

    ☆

    This paper was presented at the British Trauma Society Meeting, Crewe, Cheshire, UK in October 1999

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