Diagnostic peritoneal lavage can be useful in evaluating patients with trauma. There should be criteria for its performance, and for when to proceed immediately to exploratory laparotomy.


Indications for diagnostic peritoneal lavage:

(1) suspicion of intra-abdominal injury from blunt trauma

(2) peritoneal stab wound, with low suspicion of serious injury

(3) stab wound in chest below fourth interspace, with low suspicion of serious injury

(4) unexplained hemodynamic instability or blood loss

(5) abnormal abdominal findings on physical examination

(6) multiple rib fractures or any lower rib fracture

(7) multiple severe orthopedic injuries

(8) thoracic or lumbar spinal fractures

(9) pelvic fractures

(10) altered sensorium from any cause, including ethanol abuse

(11) paraplegia or quadraplegia following injury

(12) need for prolonged anesthesia for treatment of other injuries


Indications for immediate exploratory laparotomy:

(1) free peritoneal air on X-ray films

(2) obvious signs of peritoneal irritation on physical examination

(3) unexplained shock

(4) evidence of ruptured hemidiaphragm

(5) bleeding from upper or lower gastrointestinal tract

(6) urinary tract disruption

(7) complete loss of bowel sounds

(8) significant disruption of abdominal wall

(9) obvious, significant penetrating trauma

(10) gunshot wound to abdomen


To read more or access our algorithms and calculators, please log in or register.