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Demo Question
A 45-year-old man is injured in a high-speed road traffic crash. He is haemodynamically unstable and, after initial assessment, is found to have free fluid in the abdominal cavity on FAST scan (focussed abdominal sonography). He is taken to the operating theatre for laparotomy. At laparotomy, the main sources of bleeding are identified (in the mesentery of the small bowel).
The bleeding points are tied off and the injured sections of small bowel stapled off but not reanastamosed. It is apparent there are multiple tiny areas of bleeding, especially in the wound edges, which the surgeons describe as a general ooze
.
They close the abdomen, admit the patient to the intensive care unit, and plan to return to theatre to repair the small bowel 24 hours when the patient is more stable.
Which ONE of the following statements best describes the principle of damage control laparotomy?
Laparotomy performed to reduce contamination
Laparotomy performed to restore normal physiology
Laparotomy performed to stop bleeding
Laparotomy performed when there is acidosis
Laparotomy performed when there is coagulopathy
Key Learning Point
Damage control laparotomy favours restoration of normal physiology over anatomy
Explanation
A damage control laparotomy is performed when prolonged surgery would worsen physiology. Patients may have a triad of acidosis, hypothermia and coagulopathy. The immediate concern is to stop life-threatening bleeding and reduce contamination (staple off perforated bowel, for example) rather than reconstruct damaged tissue and reanastamose bowel. After 'abbreviated' laparotomy for damage control, the patient is resuscitated in the intensive care unit to correct abnormal physiology (warming up the patient and correcting coagulopathy, for example). Reoperation and reconstruction of anatomy is performed 24 or 48 hours later when physiology is closer to normal.
