Unreliability of standard quantitative criteria in diagnostic peritoneal lavage performed for suspected penetrating abdominal stab wounds
Article Abstract:
Patients who suffer blunt injury to the abdomen and who have possibly suffered injury to the internal organs may be evaluated by diagnostic peritoneal lavage. This procedure has a diagnostic accuracy rate of between 92 and 99 percent. Peritoneal lavage involves washing out the peritoneal cavity (the space between the layer of serous membrane covering the abdominal wall and the membrane covering the abdominal organs) with saline solution; the removed effluent fluid is then analyzed for white and red blood cell content. This procedure is now being used to evaluate patients who have suffered penetrating abdominal wounds. However, it does not appear to be as reliable in evaluating penetrating abdominal injury, as it is in evaluating blunt trauma. A report is presented of a prospective study of 35 patients who suffered stab wounds to the abdomen; physical examination of these patients on two separate occasions was inconclusive. The patients underwent diagnostic peritoneal lavage before exploratory surgery was performed. The operative findings were then compared with the cell counts of the lavage effluent. There were nine patients who underwent unnecessary surgery. Using standard red cell count criteria for diagnostic peritoneal lavage, eight patients (31 percent) with significant abdominal injury were missed; the using the white cell criteria, six significant injuries (23 percent) were overlooked. Combined use of both red and white cell count criteria failed to diagnose three injuries (12 percent). It is concluded that in equivocal cases of penetrating abdominal injury, the standard criteria for diagnostic peritoneal lavage produce is more accurate than clinical assessment, but it is not as accurate as it is when used to evaluate blunt abdominal injury. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1991
User Contributions:
Comment about this article or add new information about this topic:
The natural history of abdominal aortic aneurysms
Article Abstract:
Abdominal aortic aneurysms, localized dilations of the wall of the abdominal aorta (main trunk of the systemic arterial system) are now diagnosed using ultrasound and computed tomographic scanning. These imaging methods can identify relatively small aneurysms. The decision to operate on these abdominal aortic aneurysms is based on predictions of the rate of expansion and the risk of rupture in relation to the size of the aneurysm. To study these factors, a prospective study of 300 patients, seen over a six-year period, was undertaken. The average patient age was 70.4 years and 70 percent of the patients were men. Initial management was nonoperative. The average size of the aneurysm on initial evaluation was 4.1 centimeters (cm). There were 208 patients who underwent subsequent imaging studies; the diameter of the aneurysm increased an average of 0.3 cm per year. Of the 300 patients, 14 had rupture of their aneurysm during the study interval; four survived. The six-year incidence of ruptured aneurysm was 1 percent among patients with aneurysms less than 4.0 cm and 2 percent for those with aneurysms between 4 and 4.9 cm. The six- year incidence of rupture for patients with aneurysms over 5 cm was 20 percent. The results of this study indicate that the average rate of expansion of abdominal aortic aneurysms is 0.3 cm per year and risk of rupture is significantly lower when the aneurysm is smaller than 5.0 cm in diameter. The authors recommend that asymptomatic aneurysms that are smaller than 5 cm be followed at six-month intervals by ultrasound or CT scanning. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1991
User Contributions:
Comment about this article or add new information about this topic:
- Abstracts: The temporal association of the implementation of a fetal diagnostic and surveillance program and decreased fetal mortality in a private hospital
- Abstracts: Prevalence of otitis media with effusion in children with bilateral sensorineural hearing loss. Rehabilitation of head injured children
- Abstracts: von Willebrand factor in head and neck cancer. Intraoperative radiation therapy for recurrent head and neck cancer
- Abstracts: Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five year period
- Abstracts: Outcome of complex vascular and orthopedic injuries of the lower extremity