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Method of Gulec et al for Detection of Bowel Perforation with Gamma-Guided Diagnostic Peritoneal Lavage

Description

Diagnosis of bowel trauma may be difficult in patients with blunt trauma. Gulec et al used gamma-guided diagnostic peritoneal lavage (DPL) to detect bowel perforation in dogs using a method applicable to trauma patients. The authors are from Louisiana State University Health Sciences Center in New Orleans.


 

Equipment required: handheld gamma probe

 

Method:

(1) Administer 500 mL of saline containing 55.5 MBq of 99m-technetium sulfur colloid orally or by nasogastric tube.

(2) Perform DPL using 500 mL of saline (optimum time 90 minutes after fluid administration).

(3) Record multiple background gamma radiation counts. Determine the mean and standard deviation.

(4) Record the gamma radiation in the recovered DPL fluid multiple times and average.

 

The DPL was considered successful if > 75% of the administered fluid was recovered (or > 375 mL).

 

The DPL was considered positive if the corrected gamma count was > 10 counts in 10 seconds (this was > 3 SD above the highest background count).

 

Radiation safety:

• The surgeon was exposed to a maximum of 1 mrem per proceedure.

• The patient's urine and blood tested negative for radioactivity indicating no absorption.

• I am not sure if the patient's stool needs to be specially collected.

 

Performance:

• The sensitivity was 95% and specificity 100% at 90 minutes after the oral delivery of the technetium solution.

 


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