In damage control surgery for abdominal trauma with a coagulopathic, acidotic, hypothermic patient ('lethal triad'), the sequence of surgical steps is:

• A Definitive repair → ICU resuscitation → re-exploration
• B External fixation → laparotomy → primary bowel anastomosis
• C Immediate anastomosis with diverting stoma, then ICU
• D Abbreviated laparotomy (haemostasis + contamination control) → ICU resuscitation → definitive repair at re-look ✓

Explanation

Damage control surgery (DCS) phases: Phase 0 — resuscitation in ED; Phase I — abbreviated laparotomy: haemostasis (packing, vessel ligation) + contamination control (staple bowel ends, no anastomosis) + temporary closure (Bogota bag, Opsite, KCI VAC); Phase II — ICU correction of coagulopathy, hypothermia, acidosis; Phase III — planned re-look (24–72 hours) for definitive repair, anastomosis, and abdominal closure. Primary anastomosis in a coagulopathic, hypotensive patient risks dehiscence and anastomotic leak.

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

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Written and medically reviewed by the StethoPrep medical team.