Analysis of Peritoneal Lavage Parameters in Blunt Abdominal Trauma

Abstract

Peritoneal lavage is the most valuable diagnostic modality available for the evaluation of patients with blunt abdominal trauma. A retrospective review of 523 patients who underwent open peritoneal lavage for blunt abdominal trauma over a 31/2 yr period revealed serious intraabdominal pathology in 83% of patients undergoing laparotomy with RBC [red blood cell] lavage counts in the range of 20,000-100,000 cells/mm3, a level considered to be negative or indeterminate. Two patients with isolated small bowel perforations had an elevated amylase level as the only measured abnormality. The standard guidelines for RBC positivity (positive count > 100,000 cells/mm3 and indeterminate count 50,000-100,000 cells/mm3) result in missed i.p. injuries in a large percentage of patients and therefore require reelevation. Lavage amylase determinations, previously stated to be costly and of insignificant yield, should be performed on patients whose lavage would otherwise be considered negative by RBC and WBC [white blood cell] counts.