Damage control laparotomy in trauma hemoperitoneum

Czech version

Authors: František Vyhnánek; Martin Očadlík
Authors‘ workplace: Traumatological centre Faculty Hospital Královské Vinohrady , Department of Surgery 3. Faculty of Medicine, Charles University, Prague ; Traumatologické centrum FNKV, Chirurgická klinika 3. LF UK a FNKV, Praha
Published in: Úraz chir. 20., 2012, č.1

Věnováno k 65. narozeninám doc. MUDr. Leopolda Plevy, CSc.

Overview

Introduction:
The “damage control surgery” conception represents huge progress in procedures for severe traumas requiring immediate surgery. It is a potentially lifesaving operation in selected critically injured subjects with a lethal triad – hypothermia, acidosis and coagulopathy. Practically, the “damage control” laparotomy involves 3 phases: 1) shortened resuscitation with a rapid control of bleeding and intraabdominal contamination from the GIT contents followed by temporary occlusion of the abdomen; 2) restoration of physiological functions including increase of body temperature, correction of coagulopathy and haemodynamic stabilization at ICU; 3) reexploration for definitive treatment of the injury and occlusion of the abdominal wall. The aim of the study was to evaluate injured subjects with trauma haemoperitoneum in a blunt injury in which the damage control laparotomy procedure was indicated.

Methods and results:
37 injured individuals with polytrauma and trauma haemoperitoneum were included in the retrospective study. They were operated on in 20012011. Damage control laparotomy was performed in 26 men and 10 women. The causes of haemoperitoneum were most frequently liver injury, further spleen injury and bleeding due to fractured pelvis B and C. In 7 individuals a combination of parenchymatous organ injury together with intestinal or pelvic injury were found to be causes of bleeding. In 2 casualties with cardiac arrest on admission at emergency ward, a resuscitation thoracotomy with temporary occlusion of the descending aorta was carried out and a laparotomy followed. During laparotomy the most frequent procedure was to stop bleeding by means of a tamponade (packing) either separately or together with a local operation, i.e. suture, partial resection or even ectomy. Planned relaparotomy was carried out within 72 hours after the primary operation. From the total number 9 casualties died (25%). Cause of lethality was either irreversible haemorrhagic shock (6 individuals) or multiple craniocerebral injury (2 individuals).

Conclusions:
Indication for „damage control” laparotomy is the development of traumatogenic reaction with lethal triad with bleeding into abdominal cavity. Among leading operations of shortened laparotomy belongs temporary treatment of the source of bleeding, most commonly with a tamponade. This procedure was used especially in a liver injury and/or pelvic fracture. The causes of lethality were partly irreversible haemorrhagic shock and further multiple craniocerebral injury.

Key words:
damage control laparotomy, traumatic haemoperitoneum, indication, results.

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Labels

Surgery Traumatology Trauma surgery

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Article was published in

Trauma Surgery

2012 Issue 1