Diagnostic Peritoneal Lavage : an obituary?

Abstract

Diagnostic peritoneal lavage (DPL) has been used as a diagnostic procedure in patients with blunt abdominal trauma for almost a century. Its accuracy and reliability are high. However DPL is an invasive procedure and carries a small but significant risk of iatrogenic intra-abdominal injury. Besides, false positive rates as high as 24% have been reported with DPL. This results in unnecessary laparotomies in patients least able to withstand further insult. Ultrasonography used for the diagnosis of patients with intra-abdominal injury from blunt trauma is at least as sensitive and specific as DPL. Its positive predictive value is better than that of DPL. Besides ultrasound provides more information and can be performed rapidly. More importantly, it is non-invasive and therefore free of the complication rate associated with DPL. It is therefore no surprise that the use of DPL is declining both in Europe and the United States. Ultrasonography should be used in preference to DPL in the context of blunt abdominal trauma. Institutions receiving patients with such injuries should have 24-hour ultrasonographic facilities.