Diagnostic peritoneal lavage
Encyclopedia
Diagnostic peritoneal lavage (DPL) is a procedure where, after application of local anesthesia
, a vertical skin incision is made one third of the distance from the umbilicus
to the pubic symphysis
. The linea alba
is divided and the peritoneum entered after it has been picked up to prevent bowel perforation. A catheter is inserted towards the pelvis and aspiration of material attempted using a syringe. If no blood is aspirated, 1 litre of warm 0.9% saline is infused and after a few (usually 5) minutes this is drained and sent for analysis.
) usually secondary to trauma is suspected. In a hemodynamically unstable patient with high-risk mechanism of injury, peritoneal lavage is a means of rapidly diagnosing intra-abdominal injury requiring laparotomy, but has largely been replaced in trauma care by the FAST Ultrasound (Focussed Assessment with Sonography in Trauma) due to its repeatability, non-invasiveness and non-interference with subsequent CT scanning. Abdominal CT and contrast duodenography may complement lavage in stable patients, but in an unstable or uncooperative patient, these studies are too time-consuming or require ill-advised sedation. MRI is extremely accurate for the anatomic definition of structural injury, but logistics limit it practical application in acute abdominal trauma.
The procedure was first described in 1965.
or enteric contents (stool, food, etc.) constitutes a positive DPL, and operative exploration is warranted. Other positive findings include more than 100,000 RBC
s/mm3, 500 WBC
s/mm3, amylase
175 IU
, and detection of bile, bacteria or food fibers. Lower thresholds may also be used, which will result in fewer false-negative tests, but increase the rate of negative laparotomy
. Levels of 10,000 RBCs/mm3 are typically used in cases of penetrating trauma.
Local anesthesia
Local anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
, a vertical skin incision is made one third of the distance from the umbilicus
Navel
The navel is a scar on the abdomen caused when the umbilical cord is removed from a newborn baby...
to the pubic symphysis
Pubic symphysis
The pubic symphysis or symphysis pubis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis...
. The linea alba
Linea alba
The linea alba is a fibrous structure that runs down the midline of the abdomen in humans and other vertebrates. The name means white line and the linea alba is indeed white, being composed mostly of collagen connective tissue....
is divided and the peritoneum entered after it has been picked up to prevent bowel perforation. A catheter is inserted towards the pelvis and aspiration of material attempted using a syringe. If no blood is aspirated, 1 litre of warm 0.9% saline is infused and after a few (usually 5) minutes this is drained and sent for analysis.
Indications
This procedure is performed when intra-abdominal bleeding (hemoperitoneumHemoperitoneum
Hemoperitoneum is the presence of blood in the peritoneal cavity. The blood accumulates in the space between the inner lining of the abdominal wall and the internal abdominal organs. Hemoperitoneum is generally classified as a surgical emergency; in most cases, urgent laparotomy is needed to...
) usually secondary to trauma is suspected. In a hemodynamically unstable patient with high-risk mechanism of injury, peritoneal lavage is a means of rapidly diagnosing intra-abdominal injury requiring laparotomy, but has largely been replaced in trauma care by the FAST Ultrasound (Focussed Assessment with Sonography in Trauma) due to its repeatability, non-invasiveness and non-interference with subsequent CT scanning. Abdominal CT and contrast duodenography may complement lavage in stable patients, but in an unstable or uncooperative patient, these studies are too time-consuming or require ill-advised sedation. MRI is extremely accurate for the anatomic definition of structural injury, but logistics limit it practical application in acute abdominal trauma.
The procedure was first described in 1965.
Analysis
10ml of bloodBlood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
or enteric contents (stool, food, etc.) constitutes a positive DPL, and operative exploration is warranted. Other positive findings include more than 100,000 RBC
Red blood cell
Red blood cells are the most common type of blood cell and the vertebrate organism's principal means of delivering oxygen to the body tissues via the blood flow through the circulatory system...
s/mm3, 500 WBC
White blood cell
White blood cells, or leukocytes , are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a...
s/mm3, amylase
Amylase
Amylase is an enzyme that catalyses the breakdown of starch into sugars. Amylase is present in human saliva, where it begins the chemical process of digestion. Food that contains much starch but little sugar, such as rice and potato, taste slightly sweet as they are chewed because amylase turns...
175 IU
International unit
In pharmacology, the International Unit is a unit of measurement for the amount of a substance, based on biological activity or effect. It is abbreviated as IU, as UI , or as IE...
, and detection of bile, bacteria or food fibers. Lower thresholds may also be used, which will result in fewer false-negative tests, but increase the rate of negative laparotomy
Laparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...
. Levels of 10,000 RBCs/mm3 are typically used in cases of penetrating trauma.