Laparotomy may be done in a patient with abdominal trauma if certain clinical findings are present.


Indications for performing laparotomy (Beckingham and Krige):

(1) stab or gunshot wound that has penetrated the abdomen

(2) signs of peritonitis

(3) unexplained shock

(4) evisceration (significant disruption of the abdominal wall)

(5) uncontrolled intra-abdominal hemorrhage

(6) clinical deterioration during observation


Additional indications (Feied):

(1) free peritoneal air on X-ray films

(2) evidence of ruptured hemidiaphragm

(3) bleeding from upper or lower gastrointestinal tract

(4) urinary tract disruption

(5) complete loss of bowel sounds

(6) obvious, significant penetrating trauma to the abdomen


Other indications mentioned elsewhere in chapter:

(1) positive diagnostic peritoneal lavage or FAST study

(2) severe organ disruption (spleen, other) on CT scan


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