Computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma. Their combined role
P. A. Kearney Jr, T. Vahey, R. E. Burney and G. Glazer
Department of Surgery, University of Michigan, Ann Arbor.
We reviewed medical records and films of all 196 trauma patients who
underwent computed tomography (CT) between June 1982 and October 1986 to
see whether CT achieved the level of accuracy attributed to it, whether
diagnostic peritoneal lavage (DPL) performed in conjunction with CT was a
useful diagnostic test for blunt abdominal trauma, and whether laparotomy
was mandatory when pelvic fluid collections were seen by CT after blunt
trauma. A total of 36 patients underwent DPL, 29 before and seven after CT.
There were seven false-negative CTs that were clinically significant.
Diagnostic peritoneal lavage was positive in three patients who had
false-negative CTs. Although overall accuracy was excellent, CT was not
reliable in detecting bowel injury. Diagnostic peritoneal lavage was
helpful in detecting injuries missed by CT. Most stable patients with
moderate or large intraperitoneal fluid collections on CT accompanying
solid viscus injury were treated successfully without laparotomy.
