Diagnostic Peritoneal Lavage (DPL) can help in the assessment of patients after trauma and may indicate the need for surgical exploration.



(1) The patient is sedated, and then the stomach and urinary bladder are decompressed.

(2) A small incision is made through the anterior abdominal wall into the peritoneum below the umbilicus.

(3) A lavage catheter is introduced through the incision and directed for gravity collection of fluid.

(4) The catheter is then suctioned.

(5) If < 15 mL of gross blood is obtained, then of saline or Ringer's lactate is infused, with a volume of 10 mL per kilogram body weight , up to 1 liter

(6) The fluid is then collected through the catheter using gravity into a container. At least 600 mL needs to be recovered for reliable results.

(7) If the initial lavage is indeterminate or negative, the catheter may be left in place and a second lavage performed 2-3 hours later.





aspirate after catheter placement

> 15 mL of gross blood

<= 15 mL of gross blood; small amount at catheter insertion


lavage fluid

grossly bloody

reddish tinge


RBC count per µL after blunt trauma

> 100,000


< 50,000

RBC count per µL after penetrating trauma

> 50,000

1,000 - 50,000

< 1,000

WBC count per µL

> 500

100 - 500

< 100


>= 1750 U/L

>= 750 and < 1750 U/L

< 750 U/L


Other evidence of positive lavage:

(1) passage of lavage fluid out of Foley catheter or chest tube

(2) passage of food, foreign particles or bile in lavage fluid


Management based on lavage findings:

(1) Positive lavage: surgical exploration

(2) Indeterminate lavage: leave catheter in place and repeat lavage in 2 hours

(3) Negative lavage: remove catheter



• False positives may occur.

• False negatives occur, especially when there is injury to retroperitoneal structures (portions of the duodenum, pancreas, kidneys, adrenals) or if there are peritoneal adhesions.

• Injury to hollow organs may not be detected especially if the DPL is performed less than 3 hours after the trauma.

• Performance can be improved by making management decisions in conjunction with clinical findings such as hemodynamic instability or increased transfusion needs.


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