Assessment of ultrasonography and diagnostic Peritoneal lavage in the management of blunt Abdominal trauma.
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Diagnostic peritoneal lavage(DPL), is a well-established objective method of diagnosis of intra-abdominal injury. It is too sensitive to be used as an indicator for emergency celiotomy. With the development of ultrasonography (US), the role of DPL, has been markedly reduced. In a prospective study one hundred patients ( 65 men, 35 womens ) with a mean age of 23 15.5 years ranging between 3 to 65 years old, with blunt abdominal trauma, have been evaluated with clinical examination, then dotting US and DPL in order to detect the need for celiotomy. Patients with equivocal finding during abdominal examinations were included, while patients with stright-forward indications for emergency laparotomy were excluded. All patients underwent immediate US examinations of the abdomen by an experienced sonographer, then DPL was performed Our clinical examination were truly positive in 42%, tare negative in 22%, felse positive in 16%, felse negative in 20% with sensitivity of 67.8%, specificity of 57.9% and accuracy of 64%. US showed felse positive results in 2% and felse negative results in 6% with sensitivity of 90.3%, specificity of 94.4% and accuracy of 92%. The positive and negative predictive values were 96.6% and 85.7% respectively. DPL showed no felse positive result, and false negative results were shown in 4% with sensitivity of 93.6 %, specificity of 100 % and accuracy of 96%. The positive and negative predictive values were 100% and 90.4% respectively. US is non-invasive, simple and can localize the site of injury more specificity. DPL is accurate, safe and highly sensitive diagnostic test, it is low in cost, rapid and easy to perform and avoid disruption in patient care. Both diagnostic modalities should be used for evaluating a blunt abdominal trauma in order to decrease the number of non- theraputic laparotomies.