THE ROLE OF ULTRASONOGRAPHY AND DIAGNOSTIC PERITONEAL LAVAGE IN BLUNT ABDOMINAL TRAUMA

Abstract

Evaluation of the blunt abdominal trauma continues to be a clinical challenge. Currently, diagnostic peritoneal lavage serves as a primary diagnostic modality in the evaluation of patients with blunt abdominal trauma. Ultrasonography has been widely used in some of the emergency centers. From May 1994 to November 1995, a prospective study comparing the accuracy of diagnostic peritoneal lavage and abdominal ultrasonographic scanning was carried out in 27 patients (18 male, 9 female) with blunt abdominal trauma, admitted to our emergency department. All patients were hemodynamically stable and mean age was 27.6 years. Primarly abdominal ultrasonography then the peritoneal lavage was carried out for all the patients. According to the results, 22 of the 27 patients underwent laparotomy and remaining 5 patients were treated conservatively. Three cases had hollow viscus perforation; in none of them abdominal ultrasonographic examination was helpfull, in two of these cases peritoneal lavage was diagnostic. Sensitivity, specifity and accuracy rate were found to be 81.8 %, 80% and 81.5 % for abdominal Ultrasonography and 90.1 %, 80 %, 88.9 % for diagnostic peritoneal lavage respectively. Although ultrasonographic examination and diagnostic peritoneal lavage are important complamentary diagnostic tools in blunt abdominal trauma, we believe that Ultrasonography should be used as a screening method. If a patient has stable vital signs and negative ultrasonographic examination the patient should be observed. When a patients is hemodynamically instable and has negative ultrasonography examination, peritoneal lavage should be performed.