Ahh, remember the good old days of DPL? Probably not! But here’s an interesting case that presents a real diagnostic dilemma. Hint: this case occurred B.F. (before FAST) and B.G.C.T. (before good CT). That’s why we used DPL!

The patient was a middle aged woman who was involved in a car crash. She had mild, diffuse abdominal pain and a faint seat belt sign. She was prepared for DPL in the ED. It was performed using percutaneous (Seldinger) technique with a fenestrated catheter. Placement was in the usual position, 2cm below the umbilicus in the midline.

The aspirate was negative. A liter of LR was infused  and the bag was then lowered to drain. About 600 cc of clear amber fluid returned easily.

However, on closer inspection, a small amount of sediment could be seen in the tubing.

What the heck!? What’s going on and what, if anything, do we need to do?

Post your guesses and comments below, or Tweet them. I’ll provide hints over the weekend, and the answer on Monday.

Source: Personal archive. Not treated at Regions Hospital