Definition

DPL is an invasive diagnostic tool used in the assessment of abdominal trauma. The procedure is considered to be 98% sensitive for intraperitoneal bleeding, in experienced hands. It should be undertaken by the surgical team attending to the patient as it may alter the physical signs present.

Indications

Investigating blunt abdominal trauma.

The investigation is useful in the following circumstances:

1. ▪ Altered sensorium, head injury, patients under the influence of alcohol and/or elicit drugs.

2. ▪ Altered sensation – spinal cord injury.

3. ▪ Injury to nearby structures – ribs, pelvic fracture and spinal fracture.

4. ▪ Equivocal findings subsequent to an abdominal examination.

5. ▪ Lack of availability of ultrasound or CT scanners.

6. ▪ In a patient not stable enough to be transferred to the CT scanner.

Contraindications

The absolute contraindication is the presence of indications for an emergency laparotomy.

Relative contraindications include morbid obesity, previous significant abdominal surgery, coagulopathy and pregnancy.

Procedure

There are two main methods: (1) Open technique. (2) Closed technique.

OPEN TECHNIQUE

1. ▪ Decompress urinary bladder (catheterize patient).

2. ▪ Decompress stomach (place a nasogastric tube).

3. ▪ Surgically prepare the abdomen.

4. ▪ Locally anaesthetize the site of insertion with lidocaine +/- adrenaline, just inferior to the umbilicus.

5. ▪ Vertically incise the skin and subcutaneous tissues.

6. ▪ Lift the edges of the fascia with artery forceps. Incise the peritoneum.

7. ▪ Insert a peritoneal lavage catheter.

8. ▪ Connect a syringe and aspirate.

9. ▪ If no frank blood is aspirated, instil 1 l of warmed normal saline or Hartmann's solution via tubing.

10. ▪ Allow the fluid to mix by gently moving the abdomen.