Practical procedure- Diagnostic Peritoneal Lavage (DPL)

A naso/oro-gastric tube and urinary catheter must be in position. Under sterile conditions, after infiltration with lignocaine and 1 in 200,000 adrenaline, a vertical skin incision is made one third of the distance from the umbilicus to the symphisis pubis. The linea alba is divided and the peritoneum entered after it has been picked up to prevent bowel perforation. A peritoneal dialysis catheter is inserted towards the pelvis and aspiration of material attempted. 1 litre of warm 0.9% saline is then infused, and after a 5 minute dwell time is allowed to flow back by gravity to a bag placed on the floor.

Indications for laparotomy are: the presence of bile, enteric contents or >5mls of blood aspirated before fluid is infused, or the inability to read standard newsprint through the returned fluid in the bag.