Diagnostic peritoneal lavage. Limited indications due to evolving concepts in trauma care

This study was undertaken to determine the appropriateness of celiotomy in 100 consecutive patients who underwent celiotomy solely because of positive diagnostic peritoneal lavage (DPL) following blunt (B) or stab (S) abdominal trauma. A total of 32 (32%) patients had positive DPL by laboratory criteria: blunt trauma: greater than 100K RBC/mm3, greater than 500 WBC/mm3; stab trauma: greater than 50K RBC/mm3, greater than 250 WBC/mm3. DPL in 68 patients was positive by gross inspection; 18 of these 68 patients' DPL laboratory results returned after surgery and did not satisfy the laboratory definition of positive DPL. In all 61 per cent underwent therapeutic celiotomy (TC) and 39 per cent underwent nontherapeutic celiotomy (NTC). Grade I and II spleen and/or liver injuries led to 79 per cent of NTCs. Positive DPL, determined by gross inspection or by laboratory testing, has a very poor accuracy rate when evaluated in light of evolving beliefs that promote nonoperative therapy for grade I and II liver and spleen injuries. When positive DPL is the sole indication for celiotomy in patients with blunt or stab abdominal trauma, an unacceptably large number of NTCs will be performed. DPL should have a limited role in the evaluation of patients with abdominal trauma.