In damage control surgery for an unstable trauma patient with a grade IV liver laceration and hypothermia, which sequence best represents the damage control laparotomy (DCL) philosophy?
- A Control hemorrhage and contamination; pack and temporary abdominal closure; ICU resuscitation; planned reoperation in 24-48 hours ✓
- B Definitive anatomical repair, meticulous hemostasis, primary fascial closure with drains
- C Hepatorrhaphy, hepatic artery ligation, and primary closure in one stage
- D Angioembolization of the liver as the sole intervention
Explanation
Damage control laparotomy (DCL) is a staged approach for patients in the 'lethal triad' (hypothermia, acidosis, coagulopathy): Stage I — rapid hemorrhage control (packing, vascular clamping) and contamination control (bowel stapling without anastomosis), followed by temporary abdominal closure. Stage II — ICU resuscitation correcting the physiological derangements. Stage III — definitive repair at 24-72 hours. This approach sacrifices definitive repair in the first operation to prevent intraoperative death, with outcomes superior to attempting complete correction in a physiologically compromised patient.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.