To the Editor.—
In their article, Vij and co-workers describe a small group of patients with penetrating injuries who have a lavage fluid RBC count of less than 100,000/cu mm yet a WBC count of greater than 500/cu mm and suggest that were it not for the WBC count, these patients might not have undergone laparotomy.This is of concern because the nonsurgical emergency room physician may think that, because of the negative peritoneal lavage finding, surgical consultation need not be urgently obtained. The scene for tragedy is set. Selective management of penetrating abdominal injuries is a decision to be made by the surgeon, and most would currently explore such injuries. Certainly, peritoneal lavage in face of a gunshot wound, the path of the bullet always being uncertain, is never indicated.A recent study evaluated the morbidity of a negative finding at laparotomy in abdominal trauma.1 On review of
Bodai BI. Peritoneal Lavage White Cell Counts. JAMA. 1983;250(24):3282. doi:10.1001/jama.1983.03340240014012
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