Potential sources of error in the use of peritoneal lavage as a diagnostic tool

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.

Diagnostic peritoneal lavage

A technique for peritoneal lavage which has increased accuracy and eliminated complications is described. A curved incision is made to one side of the umbilicus at the level of the infraumbilical ring extending over the linea alba for 4 cm. The advantages of the site are its avascularity, paucity of peritoneal fat, and adherence of the peritoneum. By placing the incision at the infraumbilical ring, the rectus muscle is avoided. By adhering to the technique described, false lavage results and iatrogenic injuries to abdominal structures have been significantly decreased.

Use of laboratory animals in the teaching of emergency procedures

The Division of Emergency Medicine, University of Chicago Hospitals and Clinics uses animal laboratory sessions to train emergency medicine residents in manipulative skills. Certain animals realistically represent the human for these purposes and are delineated for various procedures. On the other hand, animal tissue characteristics and anatomical landmarks generally differ from those of humans. How procedures such as cricothyreotomy; tracheostomy, tube thoracostomy, thoractomy, cardiac repair, aortic cross clamping, venous cutdown, peritoneal lavage, abdominal stab wound exploration and laparotomy can be performed and must be modified is discussed. A rational procedural sequence is required to maintain the animal's vitality through the end of the session.

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.