Detection of occult abdominal trauma in patients with severe head injuries

Among 109 consecutive victims of severe head injury, intra-abdominal injury could not be excluded in 87. These patients were considered to be at risk from occult intra-abdominal haemorrhage. 60 patients underwent diagnostic peritoneal lavage. 10 of these had a positive lavage, correctly indicating intra-abdominal haemorrhage. In each case a lesion requiring surgical repair was identified. 49 patients had a negative lavage, and only 1 of these patients subsequently showed signs of a missed intra-abdominal lesion. 13 patients had low systolic blood-pressure (< 90 mm Hg) on admission, and 4 of these had positive lavage. Of 47 patients with systolic blood-pressure of 90 mm Hg or greater on admission, 6 had positive lavage. 15 patients were deeply comatose with no eye-opening or verbal response and an extensor or no motor response to painful stimuli. 6 of these had positive peritoneal lavage. We conclude that diagnostic peritoneal lavage should form an integral part of the evaluation of comatose patients with head injury, particularly those whose level of consciousness is most depressed, whether or not clinical signs of shock, abdominal injury, or occult haemorrhage are present.