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diagnostic peritoneal lavage (DPL)
The document discusses the investigation and management of abdominal injuries, emphasizing the importance of timely diagnosis in cases of trauma. It details various investigative methods including ultrasound, computed tomography, and diagnostic peritoneal lavage (DPL), highlighting indications, contraindications, and techniques for DPL. The document also addresses the interpretation of DPL results and potential complications associated with the procedure.
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diagnostic peritoneal lavage (DPL)
- 1. Investigation of abdominal injuries-DPL NAME -DEEPTI MALA PANNA DEPARTMENT OF SURGERY BATCH - 2018 LBRK GMC JAGDALPUR ROLL NO. - 29 MBBS FINAL YEAR PART ll
- 2. Contents ● Investigation forabdominal injuries ● Diagnostic peritoneal lavage (DPL) ○ Introduction ○ Types ○ Indications and contraindications ○ Procedure ○ Interpretation ○ Complications
- 3. Introduction Abdominal trauma isa major surgical emergency. It is associated with other systemic injuries . Although the more importance is given to other system injuries like head, thorax and bones whereas, abdominal injury is not addressed properly causing life -theatening consequences.
- 4. Patient who havesuffered abdominal injuries can classified into following categories : Haemodynamically ‘normal’- investigation can be completed before treatment is planned. Haemodynamically ‘stable’- investigation is more limited.it is aimed at establishing the patient by non - operative,angioembolisation or whether surgery. Haemodynamically ‘unstable’- investigation need to be suspended as immediate surgical correction of the bleeding is required.
- 5. Investigation Investigation are drivenby the cardiovascular status of the patient. ● Ultrasound abdomen (FAST)- it is rapid,non invasive, portable bedside method of investigation ,focusing on pericardium, splenic, hepatic and pelvic areas. It is not reliable for bowel or penetrating injuries. ● Diagnostic peritoneal lavage - it is done in case of physiologically unstable patient with blunt abdominal injury (like with spinal injury, unconscious patient).
- 6. ● Computed tomographyscan- CT scan has become the ‘gold standard’ for the intra- abdominal diagnosis of injury in the stable patient. CT Scan is sensitive for blood and individual organ injury as well as for retroperitoneal injury.
- 7. Diagnostic laparoscopy Diagnostic Laparoscopy-It is valuable in stable patient with penetrating trauma. Laparoscopy may be divided into : Screening: used to exclude a penetrating injury with breach of the peritoneum. Diagnostic: finding evidence of injury to viscera Therapeutic: used to repair the injury.
- 9. Complete blood count:Coagulation studies, grouping, cross matching. fall in Hb is an indication of on- going haemorrhage. Serum amylase/lipase: ● May be elevated because of pancreatic ishaemia due to hypotension ● Persistent elevation may be indication of pancreatic injury.
- 11. Diagnostic peritoneal lavage Introduction Diagnosticperitoneal lavage (DPL) is a test used to assess the presence of blood, cells, WBC,bile, bacteria, amylase,or contaminated gastrointestinal contents in the abdominal. It is done when FAST is not available.
- 12. Types of DPL ●Open technique (mini-laparotomy)- infraumbilical skin incision and open peritoneum cavity to directly visualize the peritoneum and incise it to insert catheter. ● Semi- open- Dissection down to the rectus fascia followed by needle and catheter-over-wire technique into the peritoneum cavity. ● Closed technique-technique- percutaneous needle insertion into the peritoneum cavity followed by catheter- over-wire.
- 13. (DPL) cont. ● Indications: 1.Unconscious trauma patient with signs of abdominal injury. 2. Patient with suspected intra- abdominal injury and equivocal physical findings. 3. Patients with multiple injuries and unexplained shock. 4. Patients with spinal cord injury. 5. Intoxicated patients in whome abdominal injury is suspected.
- 14. ● Contraindications forDPL Absolute Contraindications ● Obvious clinical indication for laparotomy ( eg.gunshot injury, penetrating injury with shock, evisceration) Relative Contraindications ● Availability of appropriate imaging(eg. E- FAST,CT). ● Pelvic fracture ● Inability to place a urethral catheter ● Pregnancy ● Previous abdominal surgery ● Obesity
- 15. Procedure Prepare the patient: ●Insert the nasogastric tube. ● Insert a urinary catheter. ● A cannula is inserted midline of the abdomen 2cm below the umbilicus angled 45° to the skin and directly inferoposteriorly towards the pelvis. ● The cannula is aspirated for blood ( ≥ 10ml is +ve) and , following 1000 ml of warmed Ringer's lactate solution is allowed to run into the abdomen and is drained out via the same route.
- 16. Interpretation One of thecriterias signifies positive lavage: ● 10 ml or more of gross blood ● RBC count more than 1,00,000/cumm ● WBC count more than 500/cumm ● Amylase level in the fluid more than 175 IU/dL ● Presence of bile , bacteria , food particles or foreign body
- 18. Complications of DPL ●Infection. ● Injury to organs and/or blood vessels by needle or catheter. ● Cutaneous bleeding and /or hematoma. ● Herniation of bowel through the incision.