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Is Closed Diagnostic Peritoneal Lavage Contraindicated in Patients with Previous Abdominal Surgery?
Author(s) -
Moore Gregory P.,
Alden Andrew W.,
Rodman George H.
Publication year - 1997
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1997.tb03550.x
Subject(s) - medicine , diagnostic peritoneal lavage , general surgery , surgery , peritoneal diseases , abdominal trauma , blunt
Objective: To compare the accuracies and complication rates of diagnostic peritoneal lavage (DPL) in trauma patients with and without previous abdominal surgery. Methods: A retrospective review of DPL accuracy and complication rate was performed using all ED trauma patients who underwent DPL during 1993 as identified by the trauma registry. Care was provided at a Level‐1 trauma center, a 1,100‐bed, central‐city teaching hospital with an annual ED census of 84,000. Records were reviewed for a history of previous surgery, DPL results, complications, mechanism of injury, and location of abdominal scars. DPL was performed using the Seldinger technique with a standard Arrow Diagnostic Peritoneal Lavage Kit using an 8‐Fr catheter. Rates for patient groups with and without previous abdominal surgery were compared using Fisher's exact test. A “misclassified” DPL was defined as either a positive DPL with negative laparotomy or a negative DPL with subsequent need for laparotomy. “Complications” were defined as iatrogenic injury during the procedure or inability to obtain return of fluid during the lavage. Results: A total of 372 DPLs were performed; 42 in patients with previous surgery and 330 in patients without prior surgery. The groups were similar with respect to proportion with blunt trauma (95% vs 97%), positive DPL (19% vs 19%), misclassified rate (2.4% vs 1.8%), and complication rate (2.4% vs 0.9%); no significant difference was found between groups. The previous abdominal surgeries were appendectomy ( n = 20), tubal ligation ( n = 5), abdominal hysterectomy ( n = 4), cholecystectomy (nonlaparoscopic) ( n = 4), pyloric stenosis ( n = 1), uterine prolapse ( n = 1), undescended testis ( n = 1), partial gastrectomy ( n = 1), and unknown ( n = 5). The analysis had a 90% power of detecting a 10% difference between the 2 groups. Conclusion: The complication rate and accuracy of closed DPL in patients with previous abdominal surgery were similar to those for DPL performed in patients without previous abdominal surgery.