In the ATLS protocol for penetrating abdominal trauma, laparotomy is mandated for which finding?

• A Isolated subcutaneous fat involvement on CT without peritoneal breach
• B A stab wound to the anterior abdominal wall with negative local wound exploration
• C Evisceration of omentum or bowel through the abdominal wound ✓
• D Transient hypotension that responds to 1 L crystalloid bolus

Explanation

Mandatory laparotomy indications for penetrating abdominal trauma include: evisceration of bowel or omentum, haemodynamic instability not responding to resuscitation, peritonism/peritonitis, free air under the diaphragm, impalement injury, diaphragmatic injury on imaging, and gunshot wounds traversing the peritoneal cavity. Evisceration is an absolute indication because it implies peritoneal breach with high probability of visceral injury and contamination. Local wound exploration to confirm or exclude fascial breach helps triage anterior stab wounds: if fascia is not breached, non-operative management is safe. For gunshot wounds, the trajectory through peritoneum automatically mandates exploration.

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

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Written and medically reviewed by the StethoPrep medical team.