Diagnostic peritoneal lavage in hemodynamically stable patients with lower chest or anterior abdominal stab wounds [Hemodinamik açıdan stabil, göǧüs altı veya ön karın bölgesinde bıçak yaralanması olan hastalarda tanısal peritoneal lavaj]

Abstract

Background Managing hemodynamically stable patients with thoracoabdominal stab wounds is still under dispute. This study aimed at discussing cut-off points of red blood cell (RBC) count in diagnostic peritoneal lavage (DPL) effluent in these patients. Methods Three hundred and eighty-eight patients with thoracoabdominal stab wounds and hemodynamically stable status were enrolled. In cases without a clear indication of laparotomy, the peritoneal cavity was washed out with 1000 ml of normal saline and the effluent fluid was analyzed for RBC count. RBC counts of >100,000/mm 3 in abdominal wounds and of >10,000/mm3 in lower chest wounds were considered as indications for exploratory laparotomy (conventional approach). New cut-off points for RBC count were calculated in backward analysis. Results Sensitivity and specificity of the conventional approach were 90% and 84%, respectively. RBC counts >15,000/ mm 3 in abdominal wounds and >25,000/mm 3 in lower chest wounds were the best cut-off points in distinguishing patients with and without need of operation, with a sensitivity and specificity of 94% and 96%, respectively. Conclusion New cut-off points of RBC count in DPL effluent may promote management of patients with thoracoabdominal stab wounds and no obvious indication for operation.