Sequential peritoneal lavage and early diagnosis of colon perforation

In order to determine the usefulness of the lavage white blood cell count as a diagnostic indicator of occult colon perforation, we subjected 20 mongrel dogs to sham laparotomy, isolated liver stab wound, or closed colon perforation and then performed sequential peritoneal lavage. The lavage white cell count rose steadily in those animals with colon perforations, and 100% of these animals had a positive lavage at six hours post-injury. After correction for the white cells shed intraperitoneally secondary to hemorrhage, the lavage white count of animals with liver wounds and of those with sham laparotomy failed to rise significantly during the period of observation. Gram stain of the lavage effluent as well as lavage amylase determination were not of diagnostic value. For solid viscus injury, lavage white cell count rises in proportion to organ hemorrhage; in hollow viscus perforation, lavage white cell count rises disproportionately and is higher than one would expect on the basis of the red cell count. We believe sequential peritoneal lavage white cell counts are of value in the diagnosis of occult colon perforation.