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Peritoneal lavage and the surgical resident
H L Walters1, J Hupp, C J McCabe
1Trauma Service, Massachusetts General Hospital, Boston 02114.
Surgery, Gynecology & Obstetrics
|December 1, 1987
Summary
Peritoneal lavage is a safe and accurate diagnostic tool for trauma patients, with a low complication rate. Surgeons in training can effectively use this method to evaluate abdominal injuries.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Diagnostic Procedures
Background:
- Peritoneal lavage is a common diagnostic method for blunt and penetrating abdominal trauma.
- Assessing the indications, technique, accuracy, and complications of peritoneal lavage is crucial for trauma care.
Purpose of the Study:
- To evaluate the indications, technique, accuracy, and complication rate of peritoneal lavage in trauma patients.
- To determine the effectiveness of peritoneal lavage when performed by resident staff trained in Advanced Trauma Life Support.
Main Methods:
- Prospective study of 161 patients undergoing peritoneal lavage for blunt and penetrating trauma.
- Utilized semiopen and open techniques, with specific criteria for positive lavage results (e.g., blood, WBC, amylase levels).
Main Results:
- High accuracy rate (93%) with low complication rate (0.6% for semiopen technique).
- Sensitivity was 94% and specificity was 93%.
- Identified specific criteria for positive lavage and discussed potential for false-positive results, especially with pelvic or retroperitoneal injuries.
Conclusions:
- Peritoneal lavage is a simple, safe, and accurate procedure for trauma evaluation by surgical residents.
- While effective, it may be less accurate for isolated intestinal, diaphragmatic, or retroperitoneal injuries compared to CT scans.
- Careful classification of positive results, excluding non-therapeutic laparotomies, is recommended.