New diagnostic peritoneal lavage (DPL) criteria for diagnosing hollow-viscus injuries
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KeywordsConservative Management Abdominal Trauma Blunt Abdominal Trauma Emergency Laparotomy Intestinal Injury
As a result of recent advances in radiological diagnostic procedures, traumatic hemoperitoneum is no longer an absolute indication for emergency laparotomy. By determining the site and extent of abdominal solid organ injuries by computed tomography (CT) and ultrasonography, conservative management can be safely adopted if the patient's vital signs are stable. However, radiological diagnosis alone is not definitive for diagnosing hollow viscus injuries as yet.
As the indications for emergency laparotomy change conceptually, the role of DPL is being transformed. For these reasons, we developed new DPL criteria specifically designed to aid in diagnosing intestinal injury. In the present study, we evaluated the effectiveness of our new DPL criteria.
Materials and methods
Until June 1996, we had performed DPL on 250 blunt abdominal trauma cases at our emergency medical center. We used our new entries to calculate diagnostic accuracy.
Analysis showed that our criteria have a diagnostic sensitivity of 96.6% and specificity of 99.4% for intestinal injury, after exclusion of 57 cases in which DPL was performed within 3 h or 18 h after injury was sustained. In 133 hemoperitoneum cases, emergency laparotomy was performed in only 48; the remaining 85 cases with negative DPL based on the white blood cell count criterion avoided surgery and conservative management resulted in no complications.
Employing our new criteria, DPL can be used to diagnose or exclude intestinal injuries even in the presence of hemoperitoneum.