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The purpose of this study was to determine objectively the optimal value or positivity criterion for red blood cell counts in diagnostic peritoneal lavage in stab wounds to the anterior abdomen. Our study group consisted of 91 consecutive adults with abdominal stab wounds who underwent peritoneal lavage. We excluded those patients who met criteria for immediate laparotomy and those with negative stab wound exploration. We divided the patients into two groups based on outcome. Group 1 consisted of those who had undergone laparotomy and had findings that required surgical intervention. Group 2 patients had either undergone laparotomy but had no injury requiring surgical intervention or had no surgery and a benign hospital course and follow-up. Receiver operator characteristic analysis was done on the diagnostic peritoneal lavage RBC counts for both groups. The overlap between the groups was minimal, with 75% of patients in Group 1 having > 120,000 RBC/mm3 and 75% of patients in Group 2 having < 486 RBC/mm3 in the lavage effluent. Using the observed probability of 23.1% of patients with abdominal stab wounds requiring surgery, a RBC count of 50,000/mm3 discriminated best those patients who required surgery from those who did not.

Study objective: The objective of this study is to determine if the peritoneal fluid culture results in the ascites patient being evaluated for spontaneous bacterial peritonitis (SBP) in the Emergency Department (ED) are used by the inpatient physician to appropriately alter empiric antibiotic treatment. Methods: We performed a retrospective study of all ascitic fluid samples sent from the ED between January 1, 2002 and December 31, 2004. Exclusion criteria included peritoneal fluid samples sent from peritoneal dialysis patients and those undergoing diagnostic peritoneal lavage for trauma. Medical records were examined to determine culture results, initial antibiotic choices, and subsequent changes in antibiotics by the inpatient physician in response to the culture results. The primary outcome measure was the percentage of cases in which ED peritoneal fluid culture results caused inpatient physicians to appropriately change antibiotic coverage. Results: There were 201 ascitic fluid samples, of which 7 (3.5%; 95% confidence interval [CI] 1.4%–7.0%) had a pathogen identified. Of these, only 1 (0.5%; 95% CI .01%–2.4%) resulted in an appropriate change in empiric antibiotic therapy. Although there were additional opportunities for appropriately using the culture results to change the antibiotic coverage in 2 (1%; 95% CI 0.1%–3.6%) patients, coverage was not changed. In fact, it was changed inappropriately in these 2 patients, and in an additional patient on appropriate empiric therapy. Conclusions: The yield from ascitic fluid cultures was low, and when positive, did not appropriately change management according to microbiologic criteria.

The management of stab wounds to the back is controversial. There are certain clear indications for exploratory laparotomy, but most cases require a diagnostic workup and a period of observation. In this article, different diagnostic modalities are presented, including local wound exploration, diagnostic peritoneal lavage, abdominal computed tomography (CT) scan, triple-contrast abdominal CT scan, and intravenous pyelography (IVP). Recommendations for management are given, with emphasis on abdominal CT scan and observation.

The diagnosis of intmabdominal injury in the patient who is victim of blunt trauma is often problematic. Currently, two procedures, diagnostic peritoneal lavage (DPL) and computed tomography (CT scan) are used to evaluate patients with possible intraabdominal injuries after blunt trauma. Controversy exists as to which of these modalities is more efficacious in this setting. There are advantages and disadvantages of both procedures, however, present evidence suggests that the clinician should not rely on the results of the CT scan. The DPL, on the other hand is a sensitive and specific modality in evaluating the patient with blunt abdominal trauma.

To facilitate documentation and assess the number and types of clinical procedures actually performed by resident physicians, we developed a microcomputer-based recording process. After completing a procedure, including resuscitations, residents recorded in a precoded book issued for each monthly rotation. At the end of each rotation, the books were collected and the information was transferred to a database program by the clerical staff. During 1989, 17 emergency medicine resident physicians at PGY levels 1 through 3 utilized this system. Completed procedure record books were submitted for 124 of 148 clinically active months for a compliance rate of 84%. Of 1,857 procedures recorded, the most frequent were resuscitation (20%), orotrachael intubation (12%), and percutaneous central vein cannulation (12%). Commonly recorded were lumbar puncture (7%), diagnostic peritoneal lavage (5%), nasotrachael intubation (4%), and newborn delivery (4%). The high compliance rate suggests resident physicians acceptance. This system enables residency directors to closely monitor individual and group procedure experiences and to make curriculum changes based on objective findings. It also provides a means of storing and retrieving data for review organizations and credentials committees.

This report describes a case of intraperitoneal rupture of a pancreatic pseudocyst (PPC) following blunt abdominal trauma. Cause of the pseudocyst was likely alcoholic pancreatitis. Peritoneal aspiration of hemorrhagic fluid prompted laparotomy and led to diagnosis. Trauma-induced intraperitoneal rupture of a preexisting PPC has been rarely reported.

Diagnostic peritoneal lavage (DPL) is a well-established procedure for evaluating the patient suspected of having intraabdominal injury secondary to blunt abdominal trauma. Its accuracy and safety have been clearly domumented; however, the procedure does have the potential for morbidity. This paper reports on the occurrence of a rare complication, dehiscence with evisceration, and reviews the literature regarding complications of DPL.