WordNet

washing out a hollow organ (especially the stomach) by flushing with water
rock that in its molten form (as magma) issues from volcanos; lava is what magma is called when it reaches the surface
of or relating to or affecting the peritoneum; "peritoneal cancer"

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(特に胃などの)洗浄
(火山から噴出する高温の)溶岩;(すでに冷えた)火山岩

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/01/14 22:32:19」(JST)

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Diagnostic peritoneal lavage (DPL) or diagnostic peritoneal aspiration (DPA) is a surgical diagnostic procedure to determine if there is free floating fluid (most often blood) in the abdominal cavity.

Indications[edit]

This procedure is performed when intra-abdominal bleeding (hemoperitoneum), usually secondary to trauma, is suspected.^[1] In a hemodynamically unstable patient with high-risk mechanism of injury, peritoneal lavage is a means of rapidly diagnosing intra-abdominal injury requiring laparotomy, but has largely been replaced in trauma care by the use of a focused assessment with sonography for trauma (FAST scan) due to its repeatability, non-invasiveness and non-interference with subsequent computed tomography (CT scan). Abdominal CT and contrast duodenography may complement lavage in stable patients, but in an unstable or uncooperative persons, these studies are too time-consuming or require ill-advised sedation. Magnetic resonance imaging is extremely accurate for the anatomic definition of structural injury, but logistics limit its practical application in acute abdominal trauma.^[2]^[3] The procedure was first described in 1965 by Hauser Root.^[4]^[5]

Procedure[edit]

After the application of local anesthesia, a vertical skin incision is made one third of the distance from the umbilicus to the pubic symphysis. The linea alba is divided and the peritoneum entered after it has been picked up to prevent bowel perforation. A catheter is inserted towards the pelvis and aspiration of material attempted using a syringe. If no blood is aspirated, 1 litre of warm 0.9% saline is infused and after a few (usually 5) minutes this is drained and sent for analysis.^[6]

Interpretation of results[edit]

If any of the following are found then the DPL is positive of trauma and operative exploration is warranted:^[7]

10 cc/blood
100,000 RBCs/mm³
500 WBCs/mm³
Presence of bile, bacteria or food particles
Serum Amylase > 175IU/ml

References[edit]

^ Rosen 2009, p. 422-4
^ Tintinalli JE, Kelen GD, Stapczynski JS (2004). Emergency Medicine: A Comprehensive Study Guide, ed 6. McGraw-Hill. pp. 1615–1616.
^ Townsed CM Jr, Beauchamp RD, Evers BM, et al (2008). Sabiston Textbook of Surgery: The Bilogical Basis of Modern Surgical Practice, ed 18. Saunders. pp. 502–504.
^ Jagminas, Liudvikas (June 18, 2012). "Diagnostic Peritoneal Lavage". Medscape. Retrieved December 31, 2012.
^ Root H, Hauser C, McKinley C, Lafave J, Mendiola R (1965). "Diagnostic peritoneal lavage.". Surgery 57: 633–7. PMID 14295771.
^ Kim, Dennis(Narrator) (July 17, 2012). Diagnostic Peritoneal Lavage (DPL). San Diego: "The Division of Trauma/Surgical Critical Care/Burns is part of the Department of Surgery, UC San Diego Health System. Event occurs at 4:00.
^ Andrew B., MD Peitzman; Andrew B. Peitzman; Michael, MD Sabom; Donald M., MD Yearly; Timothy C., MD Fabian (2002). The trauma manual. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-2641-7.

Bibliography[edit]

Rosen, Peter; John J. Ratey MD; Marx, John A.; Robert I. Simon MD; Hockberger, Robert S.; Ron Walls MD; Walls, Ron M.; Adams, James L. (2010). Rosen's emergency medicine: concepts and clinical practice. St. Louis, Mo: Mosby/Elsevier. ISBN 0-323-05472-2.

External links[edit]

Trauma Man: Images of DPL being performed on a simulator

UpToDate Contents

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1. 成人における鈍的腹部外傷の初期評価およびマネージメント initial evaluation and management of blunt abdominal trauma in adults
2. 成人外傷におけるショックの一次評価およびマネージメント initial evaluation and management of shock in adult trauma
3. 小児における腹部の鈍的外傷の概要 overview of blunt abdominal trauma in children
4. 成人患者における外傷性胃腸障害 traumatic gastrointestinal injury in the adult patient
5. 成人における重度高熱（熱射病） severe hyperthermia heat stroke in adults

English Journal

Placement of prophylactic drains after laparotomy may increase infectious complications in neonates.

Inoue M, Uchida K, Otake K, Koike Y, Okugawa Y, Kobayashi M, Mohri Y, Miki C, Kusunoki M.SourceDepartment of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174 Tsu, Mie, 514-8507, Japan.
Pediatric surgery international.Pediatr Surg Int.2011 Sep;27(9):975-9. Epub 2011 Apr 22.
PURPOSE: The aim of this study was to determine if the placement of prophylactic drains influences the incidence of postoperative adverse events in neonates.METHODS: Neonatal patients undergoing laparotomy between April 2000 and December 2007 were prospectively assigned to aggressive peritoneal cavi
PMID 21512810

Japanese Journal

直腸癌による穿孔を伴った成人腸重積症の1例

鈴木大亮,嶋村文彦,宮崎勝
日本消化器外科学会雑誌 43(3), 288-292, 2010-03-01
症例は86歳の女性で,突然の腹痛,嘔吐,腹部膨満を主訴に近医受診した.腸閉塞の診断で入院となり,保存的に経過をみるも症状改善しないため,当センター紹介となった.腹部は全体的に緊満し,腹膜刺激症状を認めた.直腸診で肛門から約3cmに比較的やわらかい隆起性病変を認め,腹部CTでは,多量の腹水,腹腔内遊離ガス像および上部直腸に重積腸管を認めた.直腸腫瘍による腸重積,および腸管穿孔,汎発性腹膜炎の診断にて …
NAID 110007574879