Diagnostic paracentesis in the acute abdomen.

on its use as a diagnostic aid in the evaluation of closed abdominal injuries, acute pancreatitis, and primary pneumococcal or streptococcal peritonitis. Though no cases were reported in their paper, they also predicted a wider use for the test in the diagnosis of ruptured hollow viscera and bleeding ectopic pregnancies. Later studies have confirmed these observations, especially in relation to blunt abdominal trauma (Thompson and Brown, 1954; Economy et al., 1960). Williams and Zollinger (1959) reviewed 273 abdominal injuries, 80% of which were nonpenetrating, and reported that needle paracentesis had proved accurate in 79% of these cases. They compared the relative diagnostic values of paracentesis and x-ray findings in the same series, and found that radiology was more valuable in injuries to kidney and bladder (where paracentesis is usually negative), but that paracentesis was far superior as a diagnostic aid in lacerations of liver, spleen, or pancreas. Keith et al. (1950) stated that it is often a useful investigation in acute pancreatitis. They obtained fluid in 12 out of 15 consecutive cases, and in all of these the amylase levels