Page 15 - WJOLS - Laparoscopic Journal

Aryan Ahmed

Fig. 3: Positive DPL test Fig. 5: Focused abdominal sonography for trauma (FAST)

DPL and FAST provide a quick access to assess the considered strongly as among the best tool in diagnosis and
internal bleeding and are very specific but not sensitive (do sometimes treatment as well.
not provide the information of the source of bleeding). The standard three ports are used (one optical and two
Usually, the unstable patients fall into this group and require operating ports) (Fig. 8); a systematic clock wise diagnostic
urgent laparotomy. 6
On the other hand, CT scan has to be used for stable
patient as it is time consuming and needs transfer to the
radiology department. It provides a sound knowledge of
injury and the source of bleeding, and is very specific in
delineating solid organ injuries.
Of the abovementioned diagnostic tools, each has its
own drawback, i.e. DPL and FAST (Figs 4 to 7) are not
informative in regards to parenchymal injuries. DPL, FAST
and CT scan—all can miss hollow viscus and diaphragmatic
injuries.
In some cases of stable blunt abdominal trauma, when
the diagnosis is of uncertainty and most of the cases of
penetrating injuries, the role of laparoscopy should be

Fig. 6: Fluid in the Morison pouch

Fig. 4: Technique of FAST Fig. 7: Fluid in the splenorenal pouch

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