ABSTRACT
Historically, abdominal trauma in hemodynamically stable patients was evaluated by serial examination or paracentesis; any abnormal findings prompted laparotomy. The introduction of diagnostic peritoneal lavage (DPL) in 1965 provided a sensitive test for the presence of intraperitoneal blood, which was deemed an indicator of serious intraabdominal injury sufficient to determine the need for surgery. The drawback of DPL is its relative lack of specificity, which is associated with nontherapeutic laparotomy rates of 20%. Computed tomography (CT) and ultrasonography (US) have also been used to evaluate abdominal trauma but are similarly limited: CT has associated rates of nontherapeutic laparotomy of up to 30%; it requires transport of the patient to the CT suite and that experienced technicians and radiologists be available. Ultrasound appears to be as sensitive as DPL for the presence of intra-abdominal fluid, but neither can determine the rate of bleeding or whether the injury is continuing to bleed or whether the injuries causing the bleedirig require surgical intervention unless serial studies are performed. Furthermore, neither test reliably detects injuries to a hollow viscus, the diaphragm, or retroperitoneum.
