Sun21November1151AM 4

In a patient admitted with trauma, is it true or false that the following are indications to proceed with a laparotomy?

True / False

Gunshot wound penetrating the peritoneal cavity Correct

Blunt trauma with a negative FAST scan and hypertension Correct

Bleeding from the stomach following penetrating trauma Correct

Blunt trauma with positive direct peritoneal lavage (DPL) Correct

Bleeding from the rectum following penetrating trauma Correct

Explanation

The Advanced Trauma Life Support (ATLS) course outlines indications for proceeding directly to laparotomy. These indications are for patients with demonstrated severe injuries on bedside testing such as by direct peritoneal lavage or by FAST scan. Also, penetrating wounds will need exploration in theatre and new onset bleeding from orifices post trauma would be an indication to proceed with laparotomy.

In addition, contrast enhanced CT scans that demonstrate perforated abdominal tract, renal pedicle injury or intraperitoneal bladder injury should be considered for urgent laparotomy.

Reference:

American College of Surgeons Committee on Trauma. Advanced Trauma Life Support for Doctors, Student Course Manual (ATLS). 8th ed. Chicago, IL: American College of Surgeons; 2008.

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