there is the introduction part of the torso trauma, check out my next ppts for further more about torso trauma. contents are in following order... introduction mechanism of injury junctional zones of torso tension pneumothorax cardiac temponade massive hemothorax etc. check out all slides

1. Investigation of
abdominal
injuries-DPL
NAME - DEEPTI MALA PANNA DEPARTMENT OF SURGERY
BATCH - 2018 LBRK GMC JAGDALPUR
ROLL NO. - 29
MBBS FINAL YEAR PART ll

2. Contents
● Investigation for abdominal injuries
● Diagnostic peritoneal lavage (DPL)
○ Introduction
○ Types
○ Indications and contraindications
○ Procedure
○ Interpretation
○ Complications

3. Introduction
Abdominal trauma is a major surgical emergency.
It is associated with other systemic injuries .
Although the more importance is given to other system
injuries like head, thorax and bones whereas, abdominal
injury is not addressed properly causing life -theatening
consequences.

4. Patient who have suffered abdominal injuries
can classified into following categories :
Haemodynamically ‘normal’- investigation can be completed
before treatment is planned.
Haemodynamically ‘stable’- investigation is more limited.it is
aimed at establishing the patient by non -
operative,angioembolisation or whether surgery.
Haemodynamically ‘unstable’- investigation need to be
suspended as immediate surgical correction of the bleeding is
required.

5. Investigation
Investigation are driven by the cardiovascular status of the
patient.
● Ultrasound abdomen (FAST)- it is rapid,non invasive,
portable bedside method of investigation ,focusing on
pericardium, splenic, hepatic and pelvic areas.
It is not reliable for bowel or penetrating injuries.
● Diagnostic peritoneal lavage - it is done in case of
physiologically unstable patient with blunt abdominal
injury (like with spinal injury, unconscious patient).

6. ● Computed tomography scan- CT scan has become
the ‘gold standard’ for the intra- abdominal diagnosis of injury
in the stable patient.
CT Scan is sensitive for blood and individual organ injury as
well as for retroperitoneal injury.

7. Diagnostic laparoscopy
Diagnostic Laparoscopy- It is valuable in stable
patient with penetrating trauma.
Laparoscopy may be divided into :
Screening: used to exclude a penetrating injury with
breach of the peritoneum.
Diagnostic: finding evidence of injury to viscera
Therapeutic: used to repair the injury.

9. Complete blood count: Coagulation
studies, grouping, cross matching. fall in Hb is an
indication of on- going haemorrhage.
Serum amylase/lipase:
● May be elevated because of pancreatic ishaemia
due to hypotension
● Persistent elevation may be indication of
pancreatic injury.

11. Diagnostic peritoneal lavage
Introduction
Diagnostic peritoneal lavage (DPL) is a test
used to assess the presence of blood, cells,
WBC,bile, bacteria, amylase,or contaminated
gastrointestinal contents in the abdominal.
It is done when FAST is not available.

12. Types of DPL
● Open technique (mini-laparotomy)- infraumbilical
skin incision and open peritoneum cavity to directly visualize
the peritoneum and incise it to insert catheter.
● Semi- open- Dissection down to the rectus fascia followed
by needle and catheter-over-wire technique into the
peritoneum cavity.
● Closed technique-technique- percutaneous needle
insertion into the peritoneum cavity followed by catheter-
over-wire.

13. (DPL) cont.
● Indications:
1. Unconscious trauma patient with signs of abdominal
injury.
2. Patient with suspected intra- abdominal injury and
equivocal physical findings.
3. Patients with multiple injuries and unexplained
shock.
4. Patients with spinal cord injury.
5. Intoxicated patients in whome abdominal injury is
suspected.

14. ● Contraindications for DPL
Absolute Contraindications
● Obvious clinical indication
for laparotomy ( eg.gunshot
injury, penetrating injury
with shock, evisceration)
Relative Contraindications
● Availability of appropriate imaging(eg.
E- FAST,CT).
● Pelvic fracture
● Inability to place a urethral catheter
● Pregnancy
● Previous abdominal surgery
● Obesity

15. Procedure
Prepare the patient:
● Insert the nasogastric tube.
● Insert a urinary catheter.
● A cannula is inserted midline of the abdomen
2cm below the umbilicus angled 45° to the
skin and directly inferoposteriorly towards
the pelvis.
● The cannula is aspirated for blood ( ≥ 10ml is
+ve) and , following 1000 ml of warmed
Ringer's lactate solution is allowed to run into
the abdomen and is drained out via the same
route.

16. Interpretation
One of the criterias signifies positive lavage:
● 10 ml or more of gross blood
● RBC count more than 1,00,000/cumm
● WBC count more than 500/cumm
● Amylase level in the fluid more than 175 IU/dL
● Presence of bile , bacteria , food particles or foreign
body

18. Complications of DPL
● Infection.
● Injury to organs and/or blood vessels by needle
or catheter.
● Cutaneous bleeding and /or hematoma.
● Herniation of bowel through the incision.