Abdominal trauma: the limited role of peritoneal lavage

Abdominal trauma was reviewed in 103 cases: 88 (85%) resulted from blunt trauma and 15 (15%) from penetrating trauma. Of the 88 cases of blunt abdominal trauma, 22 were felt to have significant intra-abdominal injuries on clinical evaluation alone. On exploration, 20 (91%) had significant injuries, one had a trivial injury, and one had negative exploration. Peritoneal lavage was performed on 66 of the 88 cases of blunt trauma. The results were positive in 36 cases. On exploration, 23 had significant injuries, nine had trivial injuries, and four had negative laparotomies. Twenty-eight lavages were negative; 26 were managed successfully without exploratory laparotomy, but two had significant injuries. Two patients had insignificant return from peritoneal lavage; both had positive laparotomies. Fourteen of 15 patients with penetrating abdominal trauma were managed by exploratory laparotomy and one was observed after negative lavage. Five of six patients explored for gunshot wounds had significant injuries. Of the eight patients explored for stab wounds, only two had significant injuries.