critical care medicine
How To Do Diagnostic Peritoneal Lavage (DPL)
Contraindications to Diagnostic Peritoneal Lavage
Absolute contraindications Obvious clinical indications for laparotomy (eg, gunshot wound to the abdomen or flank, other penetrating abdominal injury with shock, evisceration, impalement) Relative contraindications Availability of appropriate imaging (eg, E-FAST, CT) Pelvic fracture* Inability to place a urethral catheter* Pregnancy (2nd or 3rd trimester)* Previous abdominal surgery† Serious obesity‡ * Supraumbilical open DPL is needed to avoid an anteriorly spreading retroperitoneal bleeding in a pelvic fracture, distended bladder if a urethral catheter cannot be placed, or a gravid uterine fundus in a pregnant patient. † Adhesions from previous surgery make uniform distribution of fluid in the abdomen difficult and increase the risk of perforated viscus. Open DPL is done, making the incision distant from the surgical incision site (elsewhere on the midline if possible or in the left lower quadrant). ‡ Infraumbilical semi-open or open DPL is done to more safely and accurately access the peritoneal space through thick subcutaneous fat. 