How Is Peritoneal Lavage Performed?

Diagnostic peritoneal lavage is used in unstable patients who have suffered severe physical trauma.

Peritoneal lavage is a bedside procedure for evaluating bleeding in the abdominal cavity or a ruptured organ. In this procedure, a needle connected to a catheter, a tube-like structure, is inserted into your abdominal cavity. It is commonly known as diagnostic peritoneal lavage (DPL).

Diagnostic peritoneal lavage is used to evaluate the extent of abdominal trauma caused by accidents, e.g., in motor vehicle accidents. However, with the advent of computerized tomography (CT scan), the use of DPL to detect bleeding in the abdominal cavity has decreased considerably.

Diagnostic peritoneal lavage is used in unstable patients who have suffered severe physical trauma (unstable means unconscious with abnormal heart rate, blood pressure, and respiratory rate). It is an emergency diagnostic procedure that is preferred over the CT scan in these patients because a delay encountered while performing the CT scan might endanger life.

Being a bedside procedure, diagnostic peritoneal lavage is feasible in patients whose life is at stake— where every minute counts to save a life.

The conditions where peritoneal lavage is used include:

• Blunt abdominal injury: An injury that occurs due to blunt trauma to the abdomen, e.g., due to falling from a tall height to the ground, a heavy blow with a fist or with any blunt object to the abdomen, or banging the abdomen on the steering wheel during motor vehicle accidents.
• Penetrating abdominal injury: An injury that occurs when sharp instruments, weapons (stab injury), or gunshots pierce the abdomen.
• To avoid laparotomy surgery (making a large cut to open the abdomen): In many cases, the decision of when to perform a laparotomy surgery becomes quite tricky in patients who have suffered extensive trauma from an accident. Based on the findings of the diagnostic

peritoneal lavage, it becomes clear to the surgeons whether to perform surgery on the patients or try an alternative treatment. 

The conditions that make you unfit for diagnostic peritoneal lavage include:

• Prior abdominal surgery
• Abdominal-wall infections
• Coagulopathy (problems in blood clotting)
• Morbid obesity (having a body mass index [BMI] of 40 or higher)
• Last six months of pregnancy

• You will be rested on your back (supine position).
• A catheter (a rubber tube) may be inserted in your urethra and nasogastric tube (feeding tube) into your nose to avoid injury to your bladder and stomach.
• A sterile solution will be applied to the abdomen where the incision is planned.
• A local anesthetic solution will be injected to numb the area of operation.
• An incision will be made 2 cm below the umbilicus or belly button.
• A catheter with a needle will be inserted through this incision.
• The fluid will be drawn (aspiration of fluid) through the needle to check for the presence of blood. This will be done in two steps.

1. If 10 mL or more of blood is aspirated, the procedure will be stopped. 
2. If little or no blood is detected, the doctor will perform a lavage (washing) of the abdominal cavity with a normal saline solution. A small sample of the abdominal fluid will be collected and sent to the laboratory for investigation.

• A sterile solution will be applied at the site of the incision.
• The wound will be closed with sutures and then bandaged. 

• Local or systemic infection
• Hematoma (collection of blood)