A 35-year-old male involved in a high-speed motor vehicle accident is brought in with BP 80/50 mmHg, HR 130/min despite 2 litres of crystalloid. FAST examination shows free fluid in Morrison's pouch. He is taken to the operating room. According to damage control surgery (DCS) principles, which strategy is most appropriate?
- A Immediate definitive repair of all injuries in one prolonged operation
- B TAE (transarterial embolization) of hepatic artery before laparotomy
- C Initial hemorrhage control and contamination control, ICU resuscitation, then planned relook at 24–48 hours ✓
- D CT scan abdomen-pelvis to map all injuries before laparotomy
Explanation
Damage control surgery (DCS) is indicated in hemodynamically unstable patients with abdominal trauma who cannot tolerate prolonged surgery due to the lethal triad: acidosis, coagulopathy, and hypothermia. Phase 1 is abbreviated laparotomy focusing only on hemorrhage control (packing, clamping) and contamination control (bowel stapling without anastomosis). Phase 2 is ICU resuscitation to correct the lethal triad and restore physiology. Phase 3 is planned reoperation at 24–48 hours for definitive repair and reconstruction. CT scan is contraindicated in hemodynamic instability; a positive FAST mandates immediate OR. TAE has a role in pelvic fracture hemorrhage, not hepatic hemorrhage as first intervention.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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