Peritoneal lavage in blunt abdominal trauma

Abstract

Diagnosis of blunt abdominal trauma is frequently complicated by the presence of associated multiple system injuries. Diagnostic needle paracentesis has been advocated by numerous authors for many years. If nonclotting blood is recovered from the peritoneal cavity after taps in two or four quadrants, the accuracy of this adjunctive procedure has been reported as high as 95 per cent in predicting intraabdominal injury. The chance of obtaining positive results of the tap seems to be directly related to the amount of blood in the peritoneal cavity. Paracentesis is a simple quick procedure that has relatively few complications. Although abdominal paracentesis is accurate if results are positive, no information is gained if the result is negative. The major objection to the use of this test is the high percentage of falsenegative results. Because of the lack of reliability attached to negative results on paracentesis, other procedures have been sought to detect intra-abdominal injury. Canizaro, Fitts, and Sawyer [I] described the use of intraperitoneal saline infusions in animals in 1964. They consistently recovered blood-stained fluid in those animals which previously had blood injected into the peritoneal cavity and subsequently had negative results on abdominal paracentesis. In 1965 Root et al [2] described the technic of peritoneal lavage in patients. A follow-up study published in 1970 reported 304 patients in whom a 96 per cent accuracy rate was obtained [3]. This stimulated the intro-