OPEN DIAGNOSTIC PERITONEAL-LAVAGE IN BLUNT TRAUMA VICTIMS

Abstract

Open diagnostic peritoneal lavage was 97.8% accurate for diagnosis of intra-abdominal injury in 2072 blunt trauma victims. The only significant injuries missed were in certain patients with a ruptured hemidiaphragm, renal trauma and extraperitoneal bladder rupture. These injuries were identified by other means. False-positive lavage results are generally a consequence of technical error and can be minimized by careful surgical technique. Hemoperitoneum must be explained for all patients to prevent needless morbidity and mortality. Only diagnostic tests of proved value in blunt abdominal trauma should be used and risk to the patient must be minimized. Diagnostic laparotomy is relied upon to evaluate hemiperitoneum in patients with a weakly positive lavage result confirmed by a 2nd infusion. With this policy, approximately 1 of every 4-5 laparotomies was for injuries not requiring surgical therapy. The over-all morbidity rate and mortality was 12 and 3.5%, respectively, in this group. By using open diagnostic peritoneal lavage in essentially all blunt trauma victims, no deaths from unrecognized intra-abdominal injury or delayed treatment occurred.