Technic for peritoneal dialysis and diagnostic peritoneal lavage

Blunt abdominal injuries. Diagnostic peritoneal lavage, ultrasonography and computed tomography scanning

The diagnosis of blunt abdominal injuries is one of the most difficult problems in the management of trauma. There is now better understanding of the diagnostic facilities available. Guidelines regarding the use of diagnostic peritoneal lavage, ultrasonography, or computed tomography scanning should be available in the Accident and Emergency department.

A modified combination technique for performing diagnostic peritoneal lavage

Existing open diagnostic peritoneal lavage techniques (DPL) use small bore catheters, through a small lower midline incision or infra-umbilical incision. This study evaluated a modified DPL technique using a 10 mm umbilical incision, with open insertion of a 20 French peritoneal lavage catheter. The catheter has 27 radial side holes in the terminal distal 13 cm, and a female Leur lock connector. Warmed saline is infused via a cystoscopy infusion set. The time required to perform a new technique was studied in 10 patients. The median time to catheter insertion was 2.4 +/- 3.8 min, infusion time 0.75 +/- 0.3 min, effusion time 0.3 +/- 1.7 min, and a median total time of 7.6 +/- 4.2 min (median +/- s.d.). There was no complications. This technique of DPL is cosmetically attractive, much quicker than existing techniques and we have found its initial use encouraging.

Open versus closed diagnostic peritoneal lavage in the evaluation of abdominal trauma

Two hundred forty-two patients underwent diagnostic peritoneal lavage (DPL) over a 12-month period. One hundred sixteen patients (48%) were randomized to an open lavage technique and 126 (52%) to a percutaneous (closed) guide wire procedure. The closed procedure required an average of 16 minutes to complete with one operator, whereas the open method required two operators and an average time of 26 minutes (p less than 0.001). Technical complications occurred in 31 patients undergoing closed lavage (25%) and 4 patients undergoing open lavage (3%) (p less than 0.01). Fifty-eight percent of the closed lavage complications were related to fluid return and 42% to guide wire placement. All the open lavage complications were caused by inadequate fluid return. These data do not support the initial use of percutaneous lavage. The open technique is favored and certainly used when the closed method fails or when direct visualization of the peritoneal cavity is indicated. Physicians involved in the management of abdominal trauma must be familiar with both methods of DPL.

Dehiscence with evisceration: a rare complication of diagnostic peritoneal lavage

Diagnostic peritoneal lavage (DPL) is a well-established procedure for evaluating the patient suspected of having intraabdominal injury secondary to blunt abdominal trauma. Its accuracy and safety have been clearly documented; however, the procedure does have the potential for morbidity. This paper reports on the occurrence of a rare complication, dehiscence with evisceration, and reviews the literature regarding complications of DPL.

Toxic shock syndrome following diagnostic peritoneal lavage

We report the case of a 15-year-old girl who developed high fever, syncope, abdominal pain, nausea and vomiting, myalgia, pharyngitis, and a desquamating rash eight days after a diagnostic peritoneal lavage. The diagnostic peritoneal lavage wound was erythematous and tender. Incision of the site yielded 10 mL of exudate that cultured Staphylococcus aureus. The patient was treated with a first-generation cephalosporin and recovered without sequelae. To our knowledge, this is the first reported case of toxic shock syndrome following diagnostic peritoneal lavage.

Peritoneal lavage and scintigraphic evaluation of blunt abdominal trauma

The emergency management of blunt abdominal trauma requires rapid assembly of accurate information. But history, physical findings and conventional tests may be unreliable. As a result, peritoneal lavage is an integral part of the initial diagnostic protocol in many centers. However, confusion in interpretation, especially of "weak positives," can result in delayed or unnecessary celiotomy. In our regional trauma center, lavage is now reserved for selected cases based on experience with 1,833 cases "scanned" during a five-year period. The indications, contraindications, techniques, interpretation, advantages, disadvantages, and complications of lavage and scanning are presented. A protocol using radionuclide imaging for initial evaluation of blunt abdominal trauma is proposed and representative case studies are included to support this approach.

Delayed splenic rupture: diagnosed by culdocentesis

Culdocentesis is a valuable asset in the diagnosis of hemoperitoneum in women. A case report of delayed splenic rupture diagnosed by this means emphasizes its usefulness. When compared to paracentesis and peritoneal lavage, culdocentesis is more rapid, theoretically more sensitive, and easier to perform. It is a valuable diagnostic tool.