Background
At one time, diagnostic peritoneal lavage (DPL), described by Root in 1965,
was the diagnostic test of choice for detecting bleeding within the abdominal cavity after trauma. However, the advent and widespread availability of computed tomography (CT), which carries near-comparable sensitivity and superior specificity,
have limited the use of DPL to the diagnosis of intra-abdominal hemorrhage in unstable trauma patients.
Currently, DPL is performed less frequently than it once was, having been largely replaced by focused assessment with sonography for trauma (FAST) and CT. The American College of Surgeons (ACS) adopted FAST into the Advanced Trauma Life Support (ATLS) protocol, and the ninth edition of ATLS made DPL an optional skill station, owing to the widespread use of FAST. Still, each of these modalities has unique advantages and disadvantages.
DPL retains its usefulness, especially in the hemodynamically unstable trauma patient who has a negative or equivocal FAST examination. (See Technical Considerations.) Diagnostic peritoneal aspiration (DPA) is a simpler, faster modification of DPL that appears to have very low rates of failure and complications in the setting of trauma.