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Diagnostic Tests: Diagnostic Peritoneal Lavage (DPL)
When to Answer DPL
Diagnostic peritoneal lavage is indicated in the setting of blunt abdominal trauma when the patient is hemodynamically unstable or unconscious and the abdomen cannot be reliably examined. The classic scenario is a comatose or intoxicated trauma patient with multiple injuries and unexplained shock, where rapid determination of intra-abdominal bleeding is required. In this procedure, a catheter is placed into the peritoneal cavity, saline is infused, then aspirated and analyzed for evidence of injury.
Patients in Whom DPL Should NOT Be Used
DPL is not appropriate in several important clinical situations:
Findings That Make DPL Positive
A DPL is considered positive when any of the following are found in the aspirated fluid:
Any of these findings indicates significant intra-abdominal injury requiring surgical intervention.
What DPL Misses
A major limitation of DPL is that it is inadequate for detecting retroperitoneal injuries. Injuries to retroperitoneal structures such as the pancreas, kidneys, duodenum, or great vessels may be missed, making CT imaging superior in stable patients.
When to Answer DPL
Diagnostic peritoneal lavage is indicated in the setting of blunt abdominal trauma when the patient is hemodynamically unstable or unconscious and the abdomen cannot be reliably examined. The classic scenario is a comatose or intoxicated trauma patient with multiple injuries and unexplained shock, where rapid determination of intra-abdominal bleeding is required. In this procedure, a catheter is placed into the peritoneal cavity, saline is infused, then aspirated and analyzed for evidence of injury.
Patients in Whom DPL Should NOT Be Used
DPL is not appropriate in several important clinical situations:
- Patients with signs of an acute abdomen
Any evidence of a perforated viscus or clear intra-abdominal bleeding mandates immediate surgical exploration, not DPL. - Patients with gunshot wounds to the abdomen
Penetrating abdominal trauma from firearms is an indication for direct surgical exploration. - Hemodynamically stable patients with abdominal trauma
If the patient is stable and there are no definitive signs of perforation on physical exam, the correct study is an abdominal CT scan, not DPL.
Findings That Make DPL Positive
A DPL is considered positive when any of the following are found in the aspirated fluid:
- Red blood cells >100,000/mm³
- White blood cells >500/mm³
- Presence of bile
- Presence of feces
Any of these findings indicates significant intra-abdominal injury requiring surgical intervention.
What DPL Misses
A major limitation of DPL is that it is inadequate for detecting retroperitoneal injuries. Injuries to retroperitoneal structures such as the pancreas, kidneys, duodenum, or great vessels may be missed, making CT imaging superior in stable patients.
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