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Background: Some reports suggest Diagnostic peritoneal aspiration (DPA) or lavage (DPL) may better select which hypotensive blunt trauma patients (BTPs) require operation, compared to ultrasonography. However, whether both moderately hypotensive (systolic blood pressure [SBP] < 90 mmHg) and severely hypotensive (SBP < 70 mmHg) patients benefit from DPA/DPL is unclear. We hypothesized DPA/DPL used within the first hour increases risk of death for severely vs moderately hypotensive BTPs. Methods: The 2017-2019 Trauma Quality Improvement Program database was queried for BTPs ≥ 18 years old with hypotension upon arrival. We compared moderately and severely hypotensive groups. A multivariable logistic regression analysis was performed controlling for age, comorbidities, emergent operation, blood transfusions, and injury profile. Results: From 134 hypotensive patients undergoing DPA/DPL, 66 (49.3%) had severe hypotension. Patients in both groups underwent an emergent operation (43.9% vs 58.8%, P =.09) in a similar amount of time (median, 42-min vs 54-min, P =.11). Compared to the moderately hypotensive group, severely hypotensive patients had a higher rate and associated risk of death (84.8% vs 50.0%, P <.001) (OR 5.40, CI 2.07-14.11, P <.001). The strongest independent risk factor for death was age ≥ 65 (OR 24.81, CI 4.06-151.62, P <.001). Discussion: Among all BTPs undergoing DPA/DPL within the first hour of arrival, an over 5-fold increased risk of death for patients with severe hypotension was demonstrated. As such, DPA/DPL within this group should be used with caution, particularly for older patients, as they may be better served by immediate surgeries. Future prospective research is needed to confirm these findings and elucidate the ideal DPA/DPL population in the modern era of ultrasonography. [ABSTRACT FROM AUTHOR]

Background: Positive peritoneal cytology is a critical factor in prognosis. Peritoneal lavage is associated with long-term survival in patients with gastric cancer. Diagnostic peritoneal lavage (DPL) is a method for diagnosing visceral injury in trauma patients. This study aimed to investigate the usage of DPL in staging the work-up of patients with gastric cancer. Method: In this prospective study, we enrolled gastric cancer patients referring to Cancer Institute; they underwent DPL and washing specimen was sent for cytology review. After DPL, all patients underwent staging laparoscopy (SL) via the same abdominal incision. Results: DPL and SL were successful in all patients. There were six (11%) cases of peritoneal seeding discovered in SL; all of these patients had positive peritoneal cytology on DPL. Also, four patients showed positive cytology in the absence of positive SL. Thus, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of DPL were 100 % (95% CI: 54.1-100), 91.6 % (95%: 79.2-97.5), 100 % (95%CI: 85.3-100), and 60 % (95%CI: 37-79.3). The accuracy of DPL in determining the peritoneal dissemination of gastric cancer was 92.31% (95% CI: 81.5-97.9). Conclusion: DPL had an excellent ability to find peritoneal dissemination in a gastric cancer patient, which is of great value in the setting of low-resource countries.

Background: Positive peritoneal cytology is a critical factor in prognosis. Peritoneal lavage is associated with long-term survival in patients with gastric cancer. Diagnostic peritoneal lavage (DPL) is a method for diagnosing visceral injury in trauma patients. This study aimed to investigate the usage of DPL in staging the work-up of patients with gastric cancer. Method: In this prospective study, we enrolled gastric cancer patients referring to Cancer Institute; they underwent DPL and washing specimen was sent for cytology review. After DPL, all patients underwent staging laparoscopy (SL) via the same abdominal incision. Results: DPL and SL were successful in all patients. There were six (11%) cases of peritoneal seeding discovered in SL; all of these patients had positive peritoneal cytology on DPL. Also, four patients showed positive cytology in the absence of positive SL. Thus, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of DPL were 100 % (95% CI: 54.1-100), 91.6 % (95%: 79.2-97.5), 100 % (95%CI: 85.3-100), and 60 % (95%CI: 37-79.3). The accuracy of DPL in determining the peritoneal dissemination of gastric cancer was 92.31% (95% CI: 81.5-97.9). Conclusion: DPL had an excellent ability to find peritoneal dissemination in a gastric cancer patient, which is of great value in the setting of low-resource countries. [ABSTRACT FROM AUTHOR]

Abdominal trauma can be mysterious to some practitioners. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, eFAST Scan, DPL and CT scans, patients can be quickly and efficiently evaluated. To determine the positive predictive value (PPV) of computed tomography and diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma (BAT) taking surgical findings as gold standard. Study Design: Cross sectional study. Setting: Department of Surgery at Lahore General Hospital, Lahore. Period: Six months i.e. from 21.5.2016 to 20.11.2016. Materials and Methods: CT scan was performed with oral and intravenous contrast. DPL was done with sample assessment. Only those cases were included with positive findings in CT Scan or DPL. These patients underwent laparotomy under general anesthesia by a one standard surgical team. Results of surgical findings were compared between groups with CT scan and DPL. All the information was collected on predesigned proforma. Results: The mean age of the patients was 44.48±14.83 years. There were 66 (55%) males and 54 (45%) females in our study. In this study PPV for CTscan group was 90.1% while PPV for group with DPL was 51.3%. Conclusion: PPV for CT Scan group was higher than that of DPL group for diagnosing solid organ damage in patients with BAT. Hence, evidence shows that CT Scan should be used as an initial investigation of choice in haemo-dynamically stable patients with BAT. [ABSTRACT FROM AUTHOR]

In the last 30 years, the management of liver injury has evolved significantly. The advancement of imaging studies has played an important role in the conservative approach for management. A shift from operative to nonoperative management for most hemodynamically stable patients with hepatic injury has been prompted by speed and sensitivity of diagnostic imaging and by advances in critical care monitoring. In this review article, the up-to-date recommendation on the management approach of liver trauma will be discussed.

Background: In the last decade, the risk of terrorist attacks has increased largely almost worldwide. In this setting, disaster response personnel must understand the unique physiopathology of injuries as-sociated with explosions and must be prepared to assess and treat the people injured in such tragedies. The ammunition explosion in Gërdec, Vora, just 13 miles from the capital of Albania, Tirana, confronted our country with a real human tragedy with severe casualties. The striking force of the two consecutive explosions resulted in two consecutive earthquakes with respectively an amplitude of 9.2 and 2.5 on the Richter scale. Objective: To explain the classification of explosives and in connection with it to identify the major types of explosive and blast injuries, and the management options in the cases of explosions and blast injuries. Material & Methods: Efforts to dismantle Albania’s stockpiles of obsolete munitions took a catastroph-ic turn on March 15th, when a series of explosions occurred as crews were clearing out a storage depot in Gërdec, on 15th of March 2008, at 12:15 AM hours. Gërdec is located 10 km northwest of the capital of Albania, Tirana; near the national highway Tirana-Durres and at a distance of 3-4 km in air line from National Airport. Data presented here were collected from the patients’ files in our Trauma UHC and from the official reports from the different governmental offices. Conclusion: The explosive and blast injuries now present a true modern epidemic disease that threat-en the very survival of the free world. A thorough understanding of detonation and blast dynamics by the treating teams is required to better correlate the injury patterns presented. This is also critical for revision of current multiple casualty protocols. It is up to the medical establishment to prepare suitable protocols, coordinate manpower and secure medical resources to successfully handle such events.

Background: Peritoneal cytology has received little attention in the literature, but it may be an additional useful means in evaluating patients with primary gastric cancer. The aim of this study was to examine the diagnostic accuracy of peritoneal fluid lavage cytology in detecting peritoneal seeding in patients with gastric adenocarcinoma. Methods: A total of 50 patients with gastric adenocarcinoma who were candidates for laparotomy based on the findings of computed tomographic examination were recruited. Diagnostic peritoneal lavage (DPL) was performed just before laparotomy and the peritoneal lavage fluid was sent for cytological examination for presence or absence of malignant cells. Findings in terms of peritoneal involvement during laparotomy were regarded as the standard results. Results: DPL cytology was positive for the presence of malignant cells in the peritoneal fluid in 25 cases (50%). According to the intraoperative findings 22 patients (44%) had peritoneal metastatic disease, whereas in 28 patients (56%) no gross indicator of metastasis was detected. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of cytology in detecting peritoneal seeding were 59%, 57%, 52%, 64%, 1.38 and 1.40, respectively. The agreement between cytology and diagnostic laparotomy was 58%. Conclusion: According to the findings of the present study peritoneal lavage solely is not a proper diagnostic method for early recognition of resectable/nonresectable gastric cancers. [ABSTRACT FROM AUTHOR]

Background:There are a large number of patients with penetrating abdominal trauma who have normal vital signs and negative abdominal examination when referred to trauma centers. Agreat deal of controversy exists between authorities about screening these patients for emergency explorative laparotomy. Many references have reported more than 90% sensitivity for DPL as a diagnostic method to determine whether intraabdominal injuries were present and emergent laparotomy is indicated or not. This study is for reassignment of this sensitivity according to our own evidence. Methods: All of the patients with abdominal stab wounds and normal vital signs plus negative abdominal examination who were referred to Shohada-e-Tajrish hospital between March 2004 to December 2005, underwent local wound exploration and those confirmed to have peritoneal penetration, underwent emergency laparotomy. In the operating room and prior to surgery, under general anesthesia, DPL was performed. Then DPL results were compared with laparotomy findings and DPL sensitivity was assigned. Results: Of the total number of 34 patients, 8 had a positive DPL and positive laparotomy; 2 had a positive DPL and negative laparotomy; 8 had negative DPL and positive laparotomy, and 16 patients had negative DPL and negative laparotomy. Conclusion: According to our study, DPL sensitivity is much less than mentioned in trauma texts (approximately 50%). So, it is not a valuable tool to discriminate between operative and conservative approaches in penetrating abdominal trauma. We suggest more sensitive modalities. Laparotomy is the most sensitive approach but at the price of a high negative laparotomy rate.

Background: The diagnosis of small bowel and mesenteric injuries (BBMI) after blunt abdominal trauma remains difficult, which results in delayed treatment and increased mortality and morbidity. Diagnostic peritoneal lavage (DPL) in patients with 1 or 2 abnormal CT findings that are suggestive of BBMI was proposed, but the rate of unnecessary surgical exploration remains high.Patients and Methods: Blunt abdominal trauma patients with 1 or 2 CT findings predictive of BBMI from 2001 to 2014 underwent a DPL with calculation of a cell count ratio (CCR) dividing the ratio of white blood cells (WBCs) to red blood cells (RBCs) (WBC/RBC ratio) in the lavage fluid by the WBC/RBC ratio in peripheral blood. Surgical exploration of the abdomen was performed immediately in cases with a CCR≥1. CT findings, DPL and surgery results, and global outcome were analyzed.Results: Thirty-seven were included in the study (27 males, median age of 30 years (range, 17-69 years)). Exploratory laparotomy was performed in 24 patients (65%). Sixteen patients (67%) had BBMI: 7 hollow organ perforations or tears (29%), including 4 bowel resection with primary anastomosis and 3 single sutures, and 9 patients had mesenteric injuries. CT findings associated with BBMI and hollow organ perforation were large peritoneal effusion (p=0.02) and small bowel wall abnormalities (p=0.002). No postoperative complications were observed. Sensitivity and specificity of DPL for the diagnosis of bowel injuries were respectively 100% (CI 95% [59-100]) and 43% (CI 95% [25-63]). The sensitivity remained 100% (CI 95% [59-100]) when the ratio was ≥4 (n=10 patients), and the specificity reached 90% (CI 95% [73-98]).Conclusion: DPL is sensitive for the diagnosis of BBMI in stable trauma patients with 1 or 2 unexplained CT abnormalities, but specificity is low with a high rate of nontherapeutic laparotomy in case of CCR≥1. Indications for exploratory laparotomy could be restricted to patients with a CCR≥4 to improve the specificity of diagnosis management. [ABSTRACT FROM AUTHOR]