Diagnostic Peritoneal Lavage

Diagnostic peritoneal lavage (DPL) is an invasive procedure, mostly of historical significance, used to diagnose hemoperitoneum or bowel injury in patients who have experienced blunt or penetrating abdominal trauma. This procedure is now primarily used in hemodynamically unstable patients cared for in resource-constrained environments to determine the need for exploratory laparotomy. Due to the rapidly progressing use of focused assessment with sonography for trauma (FAST) and computed tomography (CT), DPL is no longer considered the primary modality for diagnosing blood in the abdominal cavity and has been removed from ATLS guidelines. The only absolute contraindication is an obvious need for laparotomy. Relative contraindications include coagulopathy, prior abdominal surgeries, abdominal wall infections, pregnancy, and morbid obesity. DPL can be done via two different approaches: open or closed. The most common technique is closed with modified Seldinger technique. The procedure can be performed via either infraumbilical or supraumbilical approach. The most common location is infraumbilical. Positive findings during a DPL indicate a need for emergent exploratory laparotomy for the hemodynamically unstable patient. Positive findings include >10 cc of frank blood or enteric contents aspirated during phase 1 of the procedure or > 100,000 RBC/mm3 and/or > 500 WBC/mm3 during phase 2 of the procedure. When resources are limited, DPL can be a useful procedure when determining the need for exploratory laparotomy after trauma.