후복막강 출혈이 동반된 복부 둔상시 진단적 복강 세척술의 의의

Diagnostic peritoneal lavage is safe, accurate, rapid and effective means in evaluating blunt abdominal trauma. However, one of major problems in this thechnic is the high sensitivity leading to a significant incidence of unnecessary laparotomies. Some investiga- tors pointed out that peritoneal lavage is an inaccurate indicator of retroperitoneal organ injury. They recommended the use of further diagnostic modalities for the diagnosis of retroperitoneal I.njuries, such as abdominal computed tomography, abdominal ultrasonogra- phy, angiography, intravenous pyelogram, cystography and gastrographic upper gastrointes- tinal series. We retrospectively reviewed medical records of 58 cases with blunt abdominal trauma accompaning retroperitoneal hemorrhage, which had been admitted to emergency room of Chonnam University Hopital from Jan, 1988 to May, 1991. All of them were performed peritoneal lavage. Fourth-nine patients had a positve peritoneal lavage and twenty-nine of fourthy-nine had intraperitoneal injury and they were performed surgiacal procedure, the others (twenty patients) had no intraperitoneal injury except retroperitoneal hemorrhge in spite of positive peritoneal lavage. Only four of twenty patients were performed surgical procedure concerned to retroperitoneal organ injury. Nine patients had a negative peritoneal lavage. There was one false negative. As he was more worsening clinically, we performed laparotomy and repaired jejunal perforation in spite of negative peritoneal lavage. We noticed a high incidence of false positive rate (41%) which led to unnecessary nine laparotomies, because they had no another intraabdominal pathologic feature except retroperitoneal hemorrahge. And seven patients were observed and then recorvered well without any complication by roentgenographic imaging studies and repeated physical examination in spite of positive peritoneal lavage. Finally, sensitivity, specificity and false positive rates of diagnostic peritoneal lavage for blunt abdominal injury accompaning retroperitonael hemorrhage are 96.7%, 28.6% and 40.8%. Thus diagnostic peritoneal lavage is an inaccurate indicator of laparotomy for blunt abdominal injury accompaning retroperi- toneal hemorrhge. We also emphasize that diagnostic peritoneal lavage should be carefully interpreted for decision to perform laparotomy so that we can avoid unnecessary laparotomies.