A 25-year-old motorcyclist presents after a high-speed collision with BP 70/50 mmHg, HR 140/min, distended abdomen, and peritonism. FAST ultrasound shows large free intraperitoneal fluid. Despite 2 litres of crystalloid, BP remains 80/50 mmHg. The concept of 'damage control surgery' is applied. Which of the following best defines damage control laparotomy (DCL)?

• A Definitive repair of all injuries in a single prolonged operation to prevent sepsis
• B Non-operative management with angioembolisation as first-line for all abdominal trauma
• C Emergency laparotomy only when all 4 haemostatic agents fail
• D Abbreviated initial surgery to control haemorrhage and contamination, followed by ICU resuscitation and planned return to theatre for definitive repair ✓

Explanation

Damage control surgery (DCS) involves a three-phase approach: Phase I — abbreviated laparotomy for haemorrhage control (packing, vascular clamping) and contamination control (bowel stapling without anastomosis) in under 60 minutes; Phase II — ICU resuscitation to correct the lethal triad (hypothermia, acidosis, coagulopathy); Phase III — planned re-look for definitive repair. DCS is indicated when physiological limits are exceeded. Prolonged definitive surgery in a coagulopathic, hypothermic patient worsens outcomes.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.