PERITONEAL-LAVAGE WHITE COUNT - A REASSESSMENT

Of 29 blunt trauma victims with a diagnostic peritoneal lavage white blood cell count (DPL:WBC) ≥ 500/mm3 as the sole positive lavage criterion, only four underwent laparotomy at admission, and only one of these had sustained intestinal perforation. Two of the remaining 25 succumbed to extra-abdominal injuries within 24 hours, leaving 23 patients, who were followed clinically for an average of 34.7 days. None was ever discovered to have sustained intestinal perforation. Throughout the study period, 27 patients were seen who had sustained intestinal perforation from blunt abdominal trauma. Nine were explored based upon an initial physical examination suggestive of peritonitis. The remaining 18 underwent DPL: 17 demonstrated gross blood, and only one patient was diagnosed solely by an elevated DPL:WBC. We conclude that DPL:WBC is a nonspecific indicator of intestinal perforation from blunt abdominal trauma, and prospective studies are needed to properly define its role. Sequential determinations of DPL:WBC may be useful in the diagnosis of intestinal perforation. © 1990 by The Williams and Wilkins Co.