Diagnostic peritoneal lavage

Diagnostic peritoneal lavage was introduced as a more accurate means than needle aspiration of assessing visceral injury following blunt abdominal trauma.

Diagnostic peritoneal lavage may be considered when there is:

• an alteration in the level of responsiveness of the patient to abdominal examination resulting from head injury, alcohol, drugs or spinal cord damage.
• absence of specific abdominal signs
• when it is impossible to continue to monitor potential changes in abdominal findings due to the patient undergoing other required procedures, e.g. neurosurgical operation or maintenance on a respirator

It is said to be up to 98% reliable in determining the presence of absence of intra-abdominal injury following blunt trauma. However, poor predictive value is found for injuries to the retroperitoneal portion of the duodenum and colon, pancreas, and extraperitoneal part of the urinary bladder. Laparoscopic diagnosis is an increasingly favoured option.