Evaluation of Diagnostic Peritoneal Lavage in Stable Patients With Gunshot Wounds to the Abdomen

Abstract

Clinical judgment is highly accurate in separating patients with tangential gunshot wounds to the abdomen from those with intra-abdominal injury but may miss patients with intra-abdominal hemorrhage. Diagnostic peritoneal lavage is highly predictive of the presence of intra-abdominal injury. The return of gross blood on aspiration or a lavage red blood cell count greater than 10 x 10(9)/L should prompt an urgent celiotomy. Missed injuries are rare and most likely to be bowel perforations. Diagnostic peritoneal lavage is an objective test that may augment clinical judgment in selecting hemodynamically stable patients with potential tangential gunshot wounds for observation and is especially useful in identifying intra-abdominal hemorrhage.

Selective Nonoperative Management of Penetrating Torso Injury From Combat Fragmentation Wounds

“…Hence, FAST provided utility primarily when results were positive, as has been demonstrated in civilian evaluations of FAST. 24 We concluded from our study that a negative FAST in a patient with penetrating truncal injuries could not rule out an intraabdominal injury, and hence these studies would usually be followed with a CT scan.…”

Penetrating Abdominal Trauma

“…In USA, Canada, Europe and other developed countries where health structures are different, signs of haemorrhage always surpass those of peritonitis in the patients presenting to hospital care. [5][6][7][8][9][10][11][12][13] For the same reasons our treatment modalities focused mostly on immediate operative treatment, because the selection of patients for non-operative treatment is initially made in the peripheral institutions; in our series we managed only 9 patients in non-operative fashion; 4 of them needed later operation due to persistent abdominal pain. Only 1 had a significant intra-abdominal injury.…”

“…Furthermore, all the GSW patients in the series had injuries requiring surgical repair, so non-operative management would have been a failure in this particular group of patients. 3,[5][6][7][8] Only 3 of the patients needed damage control surgery, but we did not expect a large number due to the small number of patients. Other locations in the country and abroad may deal with larger numbers of such cases.…”

The early management of gunshot wounds Part II: the abdomen, extremities and special situations

“…At laparotomy, 32 patients (73%) were demonstrated to have sustained intra-abdominal injury, whilst 8 did not. This conferred a positive predictive value of 96.7% and negative predictive value of 78.6% for DPL (Kelemen et al, 1998). In a larger series of 429 patients, DPL was demonstrated to have a sensitivity of 99% and specificity of 98% in predicting the need for laparotomy (Nagy et al, 1997), in patients with abdominal GSWs without peritonism, shock or with tangential wounds in which peritoneal penetration was uncertain.…”