DIAGNOSTIC PERITONEAL LAVAGE IN THE EVALUATION OF ABDOMINAL TRAUMA USING THE DIPSTICK

Abstract

Objective: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in
the assessment of intra-abdominal injury using the dipstick method.
Design: Prospective study, involving the performance of diagnostic peritoneal lavage in
the out patient department and surgical wards prior to surgical intervention.
Setting: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient
department. The study was conducted over a duration of six months, starting
from January 1995 to July 1995.
Results: Ninety six patients with penetrating(68) and blunt(28) abdominal trauma
underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal
trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood
cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic
peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy
and three (7%) had negative findings at laparatomy. The remaining 53 patients had
negative DPL results and were managed conservatively. One patient with a negative
DPL result became symptomatic and had a positive laparatomy. Conservatively managed
patients were discharged after 24 hours observations without any complications. DPL
had an accuracy and sensitivity of 93% and specificity of 98%.
Conclusion: Diagnostic peritoneal lavage is a cheap, safe and reliable method for
assessment of abdominal trauma. The method is easy to perform by trained junior
doctors in the OPD, or as a bedside procedure. Use of this method reduced negative
laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9
days. This method is recommended as a basic tool in the assessment of abdominal trauma
patients.