A 50-year-old man is brought after a high-speed road traffic accident. He is hypotensive (BP 70/40 mmHg), tachycardic (HR 140/min), and has a positive FAST showing free fluid. He receives 2 liters of crystalloid but remains hypotensive with worsening abdominal distension. His temperature is 34.5 degrees Celsius, pH 7.18, and INR 1.8. What is the most appropriate surgical strategy?
- A Damage control laparotomy with temporary abdominal closure and ICU resuscitation ✓
- B Complete definitive laparotomy with organ repair in a single operation
- C Non-operative management with serial FAST examinations
- D Angioembolisation as the sole intervention without laparotomy
Correct answer: A. Damage control laparotomy with temporary abdominal closure and ICU resuscitation
Explanation
This patient exhibits the lethal triad of trauma: hypothermia, acidosis, and coagulopathy. In this setting, prolonged definitive surgery worsens outcomes. Damage control surgery involves abbreviated laparotomy with hemorrhage and contamination control, temporary abdominal closure, and transfer to ICU for rewarming and correction of coagulopathy before planned reoperation at 24 to 48 hours.
Reference: Schwartz's Principles of Surgery, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.