Blunt and penetrating trauma to the abdomen

Laparoscopy is useful only when assessing peritoneal penetration or if diaphragmatic injury is suspected. Laparotomy remains the definitive abdominal examination, but mandatory laparotomy for abdominal penetrating injury has been abandoned in many large Trauma Centres in favour of selective conservatism. Laparotomy should proceed without prior investigation in an unstable patient with abdominal signs. The trauma laparotomy controls haemorrhage and minimizes contamination. All injuries may not be repairable at the initial laparotomy. Also, physiological status may be so deranged that damage control principles may need to be applied; the patient is returned to theatre after correction of all physiological parameters in the ICU. Temporary closure of the abdomen may be necessary because closure under tension predisposes to abdominal compartment syndrome (which is fatal in about 50% of cases in the UK).