Diagnostic peritoneal lavage

Surgical diagnostic procedure

Diagnostic peritoneal lavage
Other names	Diagnostic peritoneal aspiration
ICD-9-CM	54.25
MeSH	D010533
[edit on Wikidata]

Diagnostic peritoneal lavage (DPL) or diagnostic peritoneal aspiration (DPA) is a surgical diagnostic procedure to determine if there is free floating fluid (most often blood) in the abdominal cavity.^[1]

Indications

This procedure is performed when intra-abdominal bleeding (hemoperitoneum), usually secondary to trauma, is suspected.^[2] In a hemodynamically unstable patient with high-risk mechanism of injury, peritoneal lavage is a means of rapidly diagnosing intra-abdominal injury requiring laparotomy, but has largely been replaced in trauma care by the use of a focused assessment with sonography for trauma (FAST scan) due to its repeatability, non-invasiveness and non-interference with subsequent computed tomography (CT scan). Abdominal CT and contrast duodenography may complement lavage in stable patients, but in an unstable or uncooperative persons, these studies are too time-consuming or require ill-advised sedation. Magnetic resonance imaging is extremely accurate for the anatomic definition of structural injury, but logistics limit its practical application in acute abdominal trauma.^[3]^[4] The procedure was first described in 1965 by Hauser Root.^[5]^[6]

Procedure

After the application of local anesthesia, a vertical skin incision is made one third of the distance from the umbilicus to the pubic symphysis. The linea alba is divided and the peritoneum entered after it has been picked up to prevent bowel perforation. A catheter is inserted towards the pelvis and aspiration of material attempted using a syringe. If no blood is aspirated, 1 litre of warm 0.9% saline is infused and after a few (usually 5) minutes this is drained and sent for analysis.^[7]

Interpretation of results

If any of the following are found then the DPL is positive and operative exploration is warranted:^[8]

10 cc/blood
100,000 RBCs/mm³
500 WBCs/mm³
Presence of bile, bacteria or food particle
Amylase level > 75 IU/mL
Bilirubin level > 0.01 mg/dL
ALP > 2 IU/L

References

^ Rosen 2009, p. 22
^ Rosen 2009, p. 422-4
^ Tintinalli JE, Kelen GD, Stapczynski JS (2004). Emergency Medicine: A Comprehensive Study Guide, ed 6. McGraw-Hill. pp. 1615–1616.
^ Townsed CM Jr, Beauchamp RD, Evers BM, et al. (2008). Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, ed 18. Saunders. pp. 502–504.
^ Jagminas, Liudvikas (June 18, 2012). "Diagnostic Peritoneal Lavage". Medscape. Retrieved December 31, 2012.
^ Root H, Hauser C, McKinley C, Lafave J, Mendiola R (1965). "Diagnostic peritoneal lavage". Surgery. 57: 633–7. PMID 14295771.
^ Kim, Dennis(Narrator) (July 17, 2012). Diagnostic Peritoneal Lavage (DPL). San Diego: "The Division of Trauma/Surgical Critical Care/Burns is part of the Department of Surgery, UC San Diego Health System. Event occurs at 4:00. Archived from the original on 2021-12-19.
^ Andrew B., MD Peitzman; Andrew B. Peitzman; Michael, MD Sabom; Donald M., MD Yearly; Timothy C., MD Fabian (2002). The trauma manual. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-2641-7.

Bibliography

Rosen, Peter; John J. Ratey MD; Marx, John A.; Robert I. Simon MD; Hockberger, Robert S.; Ron Walls MD; Walls, Ron M.; Adams, James L. (2010). Rosen's emergency medicine: concepts and clinical practice. St. Louis, Mo: Mosby/Elsevier. ISBN 978-0-323-05472-0.

Tests and procedures involving the human digestive system

Digestive system surgery

Digestive tract

Upper GI tract

SGs / Esophagus	Esophagectomy Heller myotomy Sialography Impedance–pH monitoring Esophageal pH monitoring Esophageal motility study Functional Lumen Imaging Probe High resolution manometry
Stomach	Sengstaken–Blakemore tube) Nasogastric tube Gastric lavage Bariatric surgery Adjustable gastric band Endoscopic sleeve gastroplasty Gastric bypass surgery Sleeve gastrectomy Vertical banded gastroplasty surgery Collis gastroplasty Gastrectomy Billroth I Billroth II Roux-en-Y Gastroenterostomy Gastropexy Gastrostomy Percutaneous endoscopic gastrostomy Esophagogastric dissociation Hill repair Nissen fundoplication Pyloromyotomy Schilling test
Medical imaging	Endoscopy Esophagogastroduodenoscopy Barium swallow Upper gastrointestinal series

Lower GI tract

Small bowel	Bariatric surgery Duodenal switch Jejunoileal bypass Bowel resection Ileostomy Intestine transplantation Jejunostomy Partial ileal bypass surgery Strictureplasty
Large bowel	Appendectomy Colectomy Colonic polypectomy Colostomy Hartmann's operation
Rectum	Abdominoperineal resection Lower anterior resection Total mesorectal excision
Anal canal	Anal sphincterotomy Anorectal manometry Lateral internal sphincterotomy Rubber band ligation Transanal hemorrhoidal dearterialization
Medical imaging	Endoscopy: Colonoscopy Anoscopy Capsule endoscopy Enteroscopy Proctoscopy Sigmoidoscopy Abdominal ultrasonography Defecography Double-contrast barium enema Endoanal ultrasound Enteroclysis Lower gastrointestinal series Small-bowel follow-through Transrectal ultrasonography Virtual colonoscopy
Stool tests	Fecal fat test Fecal pH test Stool guaiac test

Accessory

Liver	Artificial extracorporeal liver support Bioartificial liver devices Liver dialysis Hepatectomy Liver biopsy Liver transplantation Portal hypertension Transjugular intrahepatic portosystemic shunt [TIPS] Distal splenorenal shunt procedure
Gallbladder, bile duct	Cholecystectomy Cholecystostomy ERCP Hepatoportoenterostomy Medical imaging: Cholangiography IV MRCP PTC Cholecystography Cholescintigraphy
Pancreas	Frey's procedure Pancreas transplantation Pancreatectomy Pancreaticoduodenectomy Puestow procedure

Abdominopelvic

Peritoneum	Diagnostic peritoneal lavage Intraperitoneal injection Laparoscopy Omentopexy Paracentesis Peritoneal dialysis
Hernia	Hernia repair Inguinal hernia surgery Femoral hernia repair

Other

Clinical prediction rules

Trauma

Principles

Assessment

Clinical prediction rules	Abbreviated Injury Scale Injury Severity Score NACA score Revised Trauma Score
Investigations	Diagnostic peritoneal lavage Focused assessment with sonography for trauma

Management

Principles	Advanced trauma life support Damage control surgery Early appropriate care Trauma center Trauma surgery Trauma team
Procedures	Resuscitative thoracotomy

Pathophysiology

Injury	MSK Bone fracture Degloving Joint dislocation Soft tissue injury Resp Diaphragmatic rupture Flail chest Hemothorax Pneumothorax Pulmonary contusion Cardio Cardiac tamponade Internal bleeding Thoracic aorta injury GI Blunt kidney trauma Splenic injury Neuro Intracranial hemorrhage Penetrating head injury Traumatic brain injury
Mechanism	Blast injury Blunt trauma Burn Crush injury Electrocution Gunshot wound Penetrating trauma Stab wound
Region	Abdominal trauma Chest injury Facial trauma Head injury Spinal cord injury
Demographic	Geriatric trauma Pediatric trauma