Diagnostic peritoneal lavage
- Ronald J Simon, MD
Ronald J Simon, MD
Diagnostic peritoneal aspirate and lavage is a rapid and easily performed but invasive bedside procedure that was once the gold standard for the evaluation of abdominal trauma . The procedure was initially used in patients with blunt abdominal trauma, but its use quickly evolved to include some patients with penetrating trauma [2,3]. It can provide information about injury to the solid or hollow organs, peritoneal penetration, and may also aid the diagnosis of diaphragm injury [4-6]. The procedure entails inserting a catheter into the peritoneal cavity, initially to aspirate blood or fluid, and subsequently to infuse fluid and lavage the cavity, if necessary. The initial portion of the procedure is often referred to as a diagnostic peritoneal tap or aspirate (DPA); the latter portion is a diagnostic peritoneal lavage (DPL). DPL is highly sensitive for detecting the presence of intraperitoneal blood and organ injury in blunt abdominal trauma; however, advances in technology, specifically the widespread use of computed tomography (CT) and ultrasound imaging, has led to a diminishing role for this procedure primarily because of low specificity and high rates of unnecessary laparotomy . For penetrating abdominal injury, there was a great deal of controversy over the optimal cell counts that indicated the need for laparotomy, which limited its utility.
The current role for diagnostic peritoneal lavage in the trauma patient will be reviewed here. The initial evaluation of patients with blunt and penetrating abdominal injury is presented separately. (See "Initial evaluation and management of blunt abdominal trauma in adults" and "Initial evaluation and management of abdominal stab wounds in adults" and "Initial evaluation and management of abdominal gunshot wounds in adults".)
ADVANTAGES AND DISADVANTAGES
Ultrasound (US) and abdominal computed tomography (CT) have largely replaced the use of diagnostic peritoneal lavage (DPL) in the hemodynamically stable trauma patient.
The advantages of DPL in the hemodynamically unstable trauma patient include:
●Simple and readily available instrumentation
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- ADVANTAGES AND DISADVANTAGES
- Contraindications and cautions
- DPL TECHNIQUE
- Procedure overview
- Abdominal access
- - Insertion site
- - Method
- Closure and dressing
- FLUID INTERPRETATION
- Abnormal results
- False positives
- False negatives
- SUMMARY AND RECOMMENDATIONS