The value of sequential peritoneal profile in blunt abdominal trauma

The performance of a laparotomy in hemodynamically stable patients with hemoperitoneum is based on the need to assess and control hemorrhage and to repair injuries assumed to be significant. This premise could be ignored in selected circumstances if injuries requiring intervention can be recognized early and with reasonable certainty. It is believed that a combination of traditional clinical parameters in conjunction with a modified and sequential lavage technique and a standard analysis of the effluent to include endotoxin, amylase, and corrected white blood cell determinations could increase the diagnostic accuracy in blunt abdominal trauma to permit safe observation of selected patients. Using this approach, 32 trauma victims with gross intraperitoneal blood were treated nonoperatively with no complications. In addition, four patients had gastrointestinal-pancreatic injuries detected in less than 12 hours despite negative clinical signs and red cell lavage counts.