Performance and Interpretation of Diagnostic Peritoneal Lavage

 

Procedure:

(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.

	Positive	Indeterminate	Negative
aspirate after catheter placement	> 15 mL of gross blood	<= 15 mL of gross blood; small amount at catheter insertion	none
lavage fluid	grossly bloody	reddish tinge	clear
RBC count per µL after blunt trauma	> 100,000	50,000-100,000	< 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
amylase	>= 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

 

Limitations:

• 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.