Information About Abdominal Trauma
A laparotomy is typically performed on patients who have sustained abdominal trauma, where imaging tests such as CT scans and x-rays cannot provide a diagnosis. The abdomen is opened in order to access the appendix, bladder, gallbladder, intestines, kidney, ureters, liver, pancreas, spleen, stomach, and/or uterus, fallopian tubes, and ovaries. During the procedure, a biopsy can also be taken.
Types of Abdominal Injuries
- Ruptured Spleen
- Hepatic Injury/Lacerated and Ruptured Liver
- Trauma Pancreatic Injury
- Diaphragmatic Rupture Injury
- Kidney Trauma
- Pelvic Trauma
A laparotomy can be done when someone experiences abdominal trauma after an accident, or in order to help diagnose and treat certain cancers, gallstones, endometriosis, intestinal perforations, acute appendicitis, diverticulitis, acute or chronic pancreatitis, liver or abdominal abscesses, an ectopic pregnancy, or scar tissue in the abdomen. Exploratory laparotomies should be performed in accordance with those standards associated with laparotomy.
The procedure is also sometimes known as an “exploratory laparotomy,” and often helps medical providers determine the underlying pathology and confirm a diagnosis, as well as being a therapeutic procedure. However, an exploratory laparotomy can be helpful when acute-onset of abdominal pain suggests that emergency surgery may be necessary.
A vertical midline incision is typically made in the upper, middle, or lower midline, and the surgery is guided by the initial findings. For example, massive hemoperitoneum suggests that the patient may have a major source of bleeding. Once the procedure is completed, it is crucial that the surgeon double-check to ensure that the instrument and pads are all accounted for before closing the abdominal wall.
Risks and Optimizing Patient’s Condition
There are risks associated with the procedure, including bleeding, blood clots, infection, reaction to medicines, incisional hernias, and damage to organs in the abdomen. Before the procedure is performed, your healthcare provider should undergo a complete physical exam and perform various tests to ensure that your body can tolerate the surgery and that any other medical conditions such as diabetes, lung problems, high blood pressure, etc. are under control and will not interfere with your progress. In addition, decompression of the stomach and bladder can help reduce the risk of injury during the procedure.
Procedure and Techniques
In the case of the trauma laparotomy, once the surgeon has access to the bleeding area, controlling the bleeding is the number one priority. Whether or not to fix the tissue or simply stop the bleeding is made on a case-by-case basis. In the case of the patient suffering from edematous or distended bowel, laparostomy and delayed closure is the preferred option over immediately closing the abdomen.
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