Diagnostic peritoneal lavage as an indicator for therapeutic surgery

Diagnostic peritoneal lavage (DPL) has been reported to be extremely accurate in identifying intra-abdominal injury. Many studies, however, fail to indicate clearly if the procedure is helpful in determining which patients require truly therapeutic surgical intervention, because not all injuries need such surgery. In this study the authors reviewed the charts of 174 patients with blunt abdominal trauma and, by applying strict criteria to define a therapeutic laparotomy, sought to determine, retrospectively, whether DPL was useful for indicating the need for therapeutic surgery. Although 94% of patients with positive findings from DPL underwent a laparotomy, only 65% underwent one that was clearly of therapeutic value. Although other factors may have partially contributed to the discrepancy between these results and those generally referred to in the trauma literature, this study suggests that criteria providing a strict definition of a therapeutic laparotomy must be universally applied when analysing the value of DPL.