The inadequacy of peritoneal lavage in diagnosing acute diaphragmatic rupture

Thirty-eight patients with acute diaphragmatic rupture secondary to blunt trauma have been reviewed. Peritoneal lavage is diagnostically inexact in patients with diaphragmatic rupture. One-fourth of the patients had falsely negative peritoneal lavages during their initial evaluation. All four patients without associated intra-abdominal injuries had falsely negative peritoneal lavages, as did four of 30 patients (13%) with significantly associated intra-abdominal injuries. We conclude from these data that: 1) peritoneal lavage is falsely negative in patients with isolated diaphragmatic rupture; 2) positive peritoneal lavage in patients with diaphragmatic rupture results from associated intra-abdominal injuries; and 3) peritoneal lavage may be falsely negative despite significant intra-abdominal injuries; because of herniation of injured organ(s) into the thoracic cavity, thus bleeding is excluded from the peritoneal cavity.