Diagnostic peritoneal lavage

Diagnostic peritoneal lavage
Diagnostic peritoneal lavage
Intervention
ICD-9-CM 54.25
MeSH D010533

Diagnostic peritoneal lavage (DPL) is a procedure where, after application of local anesthesia, a vertical skin incision is made one third of the distance from the umbilicus to the pubic symphysis. The linea alba is divided and the peritoneum entered after it has been picked up to prevent bowel perforation. A catheter is inserted towards the pelvis and aspiration of material attempted using a syringe. If no blood is aspirated, 1 litre of warm 0.9% saline is infused and after a few (usually 5) minutes this is drained and sent for analysis.

Contents

Indications

This procedure is performed when intra-abdominal bleeding (hemoperitoneum) usually secondary to trauma is suspected.[1] In a hemodynamically unstable patient with high-risk mechanism of injury, peritoneal lavage is a means of rapidly diagnosing intra-abdominal injury requiring laparotomy, but has largely been replaced in trauma care by the FAST Ultrasound (Focussed Assessment with Sonography in Trauma) due to its repeatability, non-invasiveness and non-interference with subsequent CT scanning. Abdominal CT and contrast duodenography may complement lavage in stable patients, but in an unstable or uncooperative patient, these studies are too time-consuming or require ill-advised sedation. MRI is extremely accurate for the anatomic definition of structural injury, but logistics limit it practical application in acute abdominal trauma.[2][3] The procedure was first described in 1965.[4]

Analysis

10ml of blood or enteric contents (stool, food, etc.) constitutes a positive DPL, and operative exploration is warranted. Other positive findings include more than 100,000 RBCs/mm3, 500 WBCs/mm3, amylase 175 IU, and detection of bile bacteria or food fibers. Lower thresholds may also be used, which will result in fewer false-negative tests, but increase the rate of negative laparotomy. Levels of 10,000 RBCs/mm3 are typically used in cases of penetrating trauma.

See also

  • Peritoneal washing

References

  1. ^ Feied C (1989). "Diagnostic peritoneal lavage. Questions and answers.". Postgrad Med 85 (4): 40–5, 49. PMID 2648366. 
  2. ^ Template:Author = Tintinalli JE, Kelen GD, Stapczynski JS
  3. ^ Template:Author = Townsed CM Jr, Beauchamp RD, Evers BM, et al
  4. ^ Root H, Hauser C, McKinley C, Lafave J, Mendiola R (1965). "Diagnostic peritoneal lavage.". Surgery 57: 633–7. PMID 14295771. 

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