Peritoneal lavage cell count ratio in blunt abdominal trauma - a useful tool in hollow viscus injury?

A 40 year old man suffered severe orthopaedic and maxillo-facial injuries in a motor vehicle accident. After resuscitation he underwent extensive orthopaedic surgery to manage his fractures. A diagnostic peritoneal lavage just prior to his operation revealed a red blood cell count of 0.15 x 10(12)/L and white blood cell count of 3.3 x 10(12)/L. However, as the patient was haemodynamically stable, a non-operative approach was adopted. Despite a normal abdominal ultrasound, near- normal abdominopelvic computed tomography, haemodynamic stability and tolerance of enteral feeding, the patient suffered a delayed sigmoid colonic perforation eight days after the initial trauma. While abdominal computed tomography has replaced diagnostic peritoneal lavage in evaluation of blunt abdominal trauma, this case highlights the need for a more effective tool for diagnosing hollow viscus injury. In this regard, the peritoneal lavage cell count ratio (which in retrospect in our patient indicated hollow viscus injury) may be useful. (author abstract)