If a unilateral junction zone injury is present, then chest tube drainage is performed prior to surgery.
Diagnostic laparoscopy is performed with low pressure (10-12 mm Hg) under general anesthesia.
If no peritoneal or diaphgramatic wounds or abnormal fluid is detected, then internal injuries are considered absent and the laparoscopy was stopped.
If a defect of the peritoneum or diaphragm is found but no obvious signs of visceral injury, then carefully examine:
(1) supracolic compartment
(2) infracolic compartment
(3) pelvis
(4) entire length of the bowel intestines
(5) lesser sac
Methylene blue tinted normal saline was infused into the stomach via a nasogastric tube if gastric injury possible.
Injuries not followed by open laparotomy:
(1) nonbleeding injuries of spleen or liver
(2) nonbleeding omental injuries
(3) mesenteric hematoma
Open laparotomy was performed for:
(1) hole in bowel
(2) actively bleeding blood vessels
(3) foreign material (clothing, bullet, etc) seen
(4) enteric fluid seen
(5) bleeding without obvious source
If the patient had a normal postoperative course, then it is assumed that no significant injuries are undetected. If the course deviates from the expected, then:
(1) other complications are excluded
(2) laparotomy is performed if rebleeding is suspected
(3) laparotomy is performed if no cause is found to explain the clinical status
