A 28-year-old trauma patient undergoes emergency laparotomy for blunt abdominal trauma. The surgeon finds diffuse faecal contamination, ongoing haemorrhage from multiple injuries, core temperature 34°C, pH 7.15, and INR 2.1. The most appropriate strategy is:
- A Definitive repair of all injuries in a single prolonged operation
- B Packing alone without any bowel resection
- C Immediate colonoscopy to assess bowel viability
- D Damage control laparotomy: haemorrhage control and contamination control, temporary abdominal closure, ICU resuscitation, planned relook at 24–48 hours ✓
Correct answer: D. Damage control laparotomy: haemorrhage control and contamination control, temporary abdominal closure, ICU resuscitation, planned relook at 24–48 hours
Explanation
The 'lethal triad' of hypothermia (34°C), acidosis (pH 7.15), and coagulopathy (INR 2.1) indicates physiological exhaustion; pursuing a prolonged definitive repair would be fatal. Damage control laparotomy — haemostasis, contamination control (bowel stapled not anastomosed), temporary abdominal closure with negative-pressure dressing — followed by ICU resuscitation and a planned relook at 24–48 hours is the standard approach.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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