What is Diagnostic Peritoneal Lavage?

Diagnostic peritoneal lavage is a clinical procedure used to check for the presence of blood in the peritoneum, or abdominal cavity. It is commonly performed in emergency rooms when patients show signs of major trauma to the abdomen. A surgeon makes a small incision under the navel and inserts a catheter to extract fluid from the peritoneum. If the fluid contains blood, the patient usually needs to undergo immediate surgery to repair the cavity and intestines and prevent life-threatening hemorrhages.

A person who is involved in a major automobile accident, a fall from height, or a confrontation that results in blunt force trauma may have internal organ and intestinal damage. Penetration injuries, such as gunshots and knife wounds, can also cause major hemorrhaging in the peritoneum. If internal bleeding is not detected and stopped right away, the risks of going into shock or experiencing sudden death increase dramatically. Doctors rely on diagnostic peritoneal lavage to quickly and reliably identify problems so the appropriate treatment decisions can be made.

Before beginning diagnostic peritoneal lavage, a surgical team takes the necessary steps to stabilize the patient and provide local anesthetic. A Foley catheter and a gastric tube are usually inserted into the bladder and empty the stomach. A small vertical cut is then made just underneath the navel and a catheter is maneuvered to the inner space of the peritoneum. A small amount of clear saline solution is infused. Next, the surgeon usually removes the catheter, stitches the incision, and rocks the patient back and forth to distribute the saline throughout the cavity.

After about five minutes, the incision is reopened and the surgeon draws out the fluid. If the solution obviously contains blood, surgery is immediately considered. Clear fluid is sent to a lab to determine if small blood traces are present. When diagnostic peritoneal lavage is positive for blood, open surgery is performed to locate and repair the hemorrhage site.

In many cases, surgeons prefer to use ultrasounds and computerized tomography scans over diagnostic peritoneal lavage to check for intra-abdominal trauma. Imaging tests are entirely non-invasive, and they are usually very accurate. In certain cases, however, it is not safe or practical to conduct imaging tests. Diagnostic peritoneal lavage is used if imaging technology is unavailable or if a patient is in unstable condition due to multiple injuries. When possible, both lavage techniques and ultrasounds are often performed to put more confidence in the diagnosis.