IS CLOSED DIAGNOSTIC PERITONEAL-LAVAGE CONTRAINDICATED IN PATIENTS WITH PREVIOUS ABDOMINAL-SURGERY

Objective: To compare the accuracies and complication rates of diagnos tic peritoneal lavage (DPL) in trauma patients with and without previo us abdominal surgery. Methods: A retrospective review of DPL accuracy and complication rate was performed using all ED trauma patients who u nderwent DPL during 1993 as identified by the trauma registry. Care wa s provided at a Level-1 trauma center, a 1,100-bed, central-city teach ing hospital with an annual ED census of 84,000. Records were reviewed for a history of previous surgery, DPL results, complications, mechan ism of injury, and location of abdominal scars, DPL was performed usin g the Seldinger technique with a standard Arrow Diagnostic Peritoneal Lavage Kit using an 8-Fr catheter, Rates for patient groups with and w ithout previous abdominal surgery were compared using Fisher's exact t est. A ''misclassified'' DPL was defined as either a positive DPL with negative laparotomy or a negative DPL with subsequent need for laparo tomy, ''Complications'' were defined as iatrogenic injury during the p rocedure or inability to obtain return of fluid during the lavage. Res ults: A total of 372 DPLs were performed; 42 in patients with previous surgery and 330 in patients without prior surgery. The groups were si milar with respect to proportion with blunt trauma (95% vs 97%), posit ive DPL (19% vs 19%), misclassified rate (2.4% vs 1.8%), and complicat ion rate (2.4% vs 0.9%); no significant difference was found between g roups, The previous abdominal surgeries were appendectomy (n = 20), tu bal ligation (n = 5), abdominal hysterectomy (n = 4), cholecystectomy (nonlaparoscopic) (n = 4), pyloric stenosis (n = 1), uterine prolapse (n = 1), undescended testis (n = 1), partial gastrectomy (n = 1), and unknown (n = 5), The analysis had a 90% power of detecting a 10% diffe rence between the 2 groups. Conclusion: The complication rate and accu racy of closed DPL in patients with previous abdominal surgery were si milar to those for DPL performed in patients without previous abdomina l surgery.