Which procedures are performed in the workup of intestinal perforation?

Updated: Jul 24, 2020
  • Author: Samy A Azer, MD, PhD, MPH; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Laparoscopy may significantly improve surgical decision making in patients with acute abdominal pain, particularly when the need for operation is uncertain.

Peritoneal diagnostic tap may be useful in determining the presence of intra-abdominal blood, fluid, and pus.

Peritoneal lavage is more valuable in the presence of a history of blunt abdominal trauma. The presence of blood or purulent material or the detection of bacteria on Gram stain suggests the need for early surgical exploration. Alkaline phosphatase concentration in the peritoneal lavage is a helpful and sensitive test that may be used to detect occult blunt intestinal injuries. A concentration greater than 10 IU/L has been shown to be a sensitive and reliable test in the detection of occult small bowel injuries.

Fine-catheter peritoneal cytology involves the insertion of a venous cannula into the peritoneal cavity, through which a fine umbilical catheter is inserted while the patient is under local anesthesia. Peritoneal fluid is aspirated, placed on a slide, and stained for examination under a light microscope for percentage of polymorphonuclear cells. A value greater than 50% suggests a significant underlying inflammatory process. This test, however, provides no clue as to the exact cause of inflammation.


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