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Diagnostic peritoneal lavage
- indicated when there is haemodynamic instability with unreliable clinical
findings (eg due to head injury, intoxication or paraplegia) or if abdominal
examination is equivocal (eg lower rib, lumbar spine or pelvic fractures causing
abdominal tenderness and tensing) or if abdominal examination of a repeated
nature is impractical because of anticipated lengthy x-ray studies or GA for
extra-abdominal injuries
- detects free blood in abdominal cavity with 97% accuracy
- insert NG tube and urinary catheter prior to DPL
- open or closed methods both satisfactory although open preferred
- only absolute contraindication is an existing indication for laparotomy
- relatively contra-indicated in pregnancy, significant obesity and previous
abdominal surgery. In these situations (or with pelvic fractures)
supra-umbilical open method should be used
- early DPL is reliable in presence of pelvic
fractures
Criteria for positive DPL:
- Clinical criteria
- Initial aspiration of >10 ml frank blood
- Egress of lavage fluid through chest drain or urinary catheter
- Bile or vegetable material in lavage fluid
- Laboratory criteria (lab criteria, especially for penetrating injury
remain debatable)
|
Test |
Blunt trauma |
Penetrating |
|
RBC (definite injury) |
>100 000/ml |
>20 000/ml |
|
RBC (indeterminate) |
50-100 000 |
5-20 000 |
|
WCC |
>500/ml |
>500/ml |
|
Amylase |
>20 IU/L |
>20 IU/L |
|
Alkaline phosphatase |
>10 IU/L |
>10 IU/L |
If laboratory analysis is not available a rough alternative for a positive
DPL is inability to read newsprint through the tubing leading from the PD
catheter because of the presence of blood
- note that a negative laparotomy does not exclude retroperitoneal injury and
that false negatives do occur. These are usually due to isolated injury to
pancreas, duodenum, diaphragm, small bowel or bladder
- if non-operative management for organ injury may be best, DPL may not be
indicated and a CT scan may be preferable
- DPL will generally leave some fluid in the peritoneal cavity which will
adversely affect the interpretation of any subsequent CT scans
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