A 32-year-old male sustains a penetrating abdominal stab wound. At laparotomy, a mesenteric vessel injury is controlled but the small bowel shows ischaemic segments with contamination. The decision is made for damage control surgery. After temporary abdominal closure, within what time frame should the planned re-look laparotomy be performed?

• A Within 6 hours
• B 24–48 hours after damage control laparotomy ✓
• C 72–96 hours after damage control laparotomy
• D Only when the patient has fully recovered (7–10 days)

Explanation

Damage control surgery (DCS) involves an abbreviated initial laparotomy for haemorrhage and contamination control followed by physiological resuscitation in ICU (correcting the lethal triad: hypothermia, coagulopathy, acidosis). Re-look laparotomy for definitive repair is planned at 24–48 hours, by which time the patient's physiology should be corrected, allowing safe bowel resection and anastomosis or stoma formation. Delays beyond 48–72 hours increase anastomotic failure and abscess rates.

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

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Written and medically reviewed by the StethoPrep medical team.