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Diagnostic peritoneal lavage (DPL) is a useful test to determine which patients require a laparotomy based upon the presence of a hemoperitoneum. The physical examination may be misleading in up to 45 percent of patients with blunt abdominal trauma. It is helpful to use the DPL to diagnose the need for a laparotomy sooner and with greater accuracy.1,2

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The technique of DPL was first described in 1964 by Dr. Root in an attempt to improve the identification of the patient with blunt abdominal trauma who required a laparotomy.3 His description of the DPL represented an improvement upon the use of paracentesis to identify a hemoperitoneum as described by Salomon in 1906.4 Root’s initial description of DPL utilized a trocar placed into the peritoneal cavity to instill fluid. The fluid was visually inspected upon removal and the patient then underwent a laparotomy if it appeared bloody.

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DPL has undergone several modifications since its initial description. The trocar technique was abandoned first in favor of the open technique and later the Seldinger or closed technique.5,6 While the DPL was first described for blunt trauma, it has found an indication in the patient with penetrating trauma as well.2 Initial attempts to quantify the effluent based on its appearance have been replaced by the red blood cell count, the white blood cell count, and the measurement of various enzymes.7–9 The debate still rages in the literature as to which criterion best determines the need for laparotomy.

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The gross anatomy of the abdomen is well known to practitioners and is important to review when preparing for a DPL. The abdominal cavity is lined by the peritoneum and is protected from the environment by the abdominal wall musculature, fat, and skin. The right and left rectus muscles, which are nourished by the epigastric vessels, meet in the midline at the avascular linea alba. The umbilicus is located along the lower portion of the linea alba. The layers of the anterior abdominal wall structures vary above and below the level of the anterior superior iliac spine (Figure 55-1).

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FIGURE 55-1
Graphic Jump Location

The layers of the anterior abdominal wall vary above (A) and below (B) the level of the anterior superior iliac spine.

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DPL, unlike a paracentesis, is always performed in the anterior midline of the abdomen (Figure 55-2). The linea alba is an avascular location through which the peritoneal cavity may be entered using either an open technique or a closed Seldinger type technique. This midline location minimizes the number of false positive lavages that occur due to bleeding from the abdominal wall muscles or blood vessels. This also allows the Surgeon to perform a midline laparotomy, if necessary, through the lavage site and avoid the formation of an ...

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