Indications and principles of trauma laparotomy and be familiar with principles of damage control laparotomy. Trauma Laparotomy. Description and indications. Indicated when there is a strong suspicion of intra-abdominal injuries due to blunt or penetrating trauma. Key indications: Hemodynamic instability: Patient in shock and there is no other clear cause -> laparoscopy is often necessary. Peritonitis Look for signs of this: Abdominal pain Tenderness Guarding Tenderness on percussion. Principles Stop the bleeding: Primary goal is to control the bleeding. Limit contamination E.g. if there is bowel perforation. Take steps to prevent further bacterial spread. Reconstruction whenever possible Definitive repair after doing the above two. Damage Control Laparotomy Indications: Used then there is a critically injured patients with abdominal trauma. Rapid definitive repair is not feasible due to patient’s unstable condition. Key indications: Severe bleeding Life threatening. Contamination Manage contamination e.g. bowel perforation, spillage of contents Hemodynamic instability When the patient is in shock and needs resus. Principles Initial control: Rapid control of bleeding and contamination during the initial surgery. Stabilization Patients are then stabilised in the ICU to improve overall condition. Definitive repair later Goal is to return the patient to a stable state before planning definitive repair in subsequent surgeries. Temporary abdominal closure A temporary closure is performed at the end of the initial operation to facilitate reoperation and prevent abdominal compartment syndrome.