Intra‐abdominal injuries in polytrauma

The most important preoperative objective in the management of the patient with abdominal trauma is to ascertain whether or not a laparotomy is needed and not the diagnosis of a specific organ injury. This objective is complicated in multiple trauma patients by the extra‐abdominal injuries which change the abdominal findings. Peritoneal lavage is of great help in making this decision. The second important decision relates to whether or not the control of abdominal blood loss is to be achieved as a part of or after cardiopulmonary resuscitation. Clearly, the blood bank must be alerted and sufficient personnel must be available to pump the blood. Such surgery must always be conducted under full physiologic monitoring of cardiopulmonary function, with a warming blanket to prevent hypothermia, and with x‐ray facilities. The third decision concerns the role of the laparotomy in the treatment of the other injuries the patient has received. It is usually wise to have 2 operating teams at work . Given the nature of blunt trauma it is wise to prepare the patient from the sternal notch to mid‐thighs so that any surgical eventuality may be managed. This is associated with a long midline incision. The first operative objective is control of hemorrhage; the second, prevention of further contamination; and the third, a precise diagnosis of the anatomy of each injury. The subsequent objectives for liver, pancreaticoduodenal, gastrointestinal, and splenic injuries are discussed in detail. In the severely contaminated abdomen, delayed primary closure of the wound above the fascia is utilized .