Which condition is most likely to be missed by diagnostic peritoneal lavage (DPL)?

Diagnostic peritoneal lavage (DPL) is a procedure used to diagnose intra-abdominal injuries by analyzing the peritoneal fluid collected during the lavage. It is particularly valuable in assessing blunt abdominal trauma. However, certain conditions may escape detection by this method due to the nature of how they present or the type of injuries they cause.

A subcapsular hematoma of the spleen may remain undetected by DPL because the hematoma can be confined beneath the splenic capsule without significant free blood in the peritoneal cavity. Since DPL primarily detects free blood or the presence of abdominal contents in the peritoneal space, it may not reveal a localized injury like a subcapsular hematoma that does not communicate with the peritoneal cavity.

In contrast, conditions like pelvic fractures, chest injuries, and abdominal aortic aneurysms are more likely to be associated with blood in the peritoneal cavity or may be assessed more thoroughly through other imaging techniques. For instance, pelvic fractures may cause bleeding that is detected by DPL as the blood can pool due to gravity. Chest injuries are often evaluated through chest imaging rather than DPL, and abdominal aortic aneurysm rupture typically leads to significant blood in the peritoneal cavity that