Peritoneal lavage. Its unreliability in gunshot wounds of the lower chest and abdomen.

The accuracy of peritoneal lavage in patients with gunshot wounds has not been previously reported. A prospective study comprised of 168 patients was designed to determine the reliability of physical examination and peritoneal lavage. Patients sustaining gunshot wounds to the lower chest and abdomen underwent clinical assessment followed up by lavage prior to operation. There was 20.2% false-negative and 15.9% false-positive physical examination results. Of the patients. 25.4% with a false-negative lavage results had a positive celiotomy. Six of 15 patients with false-negative lavage results had RBC counts less than 1,000/cu mm. Gunshot wounds differ from stab wounds because of the unpredictable trajectory, blast effect, and high likelihood of visceral injury. It can be concluded from this study that because of the inconsistent results of both lavage and physical examination, patients who sustain gunshot wounds are best treated by exploratory celiotomy.