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Exploratory laparotomy

abdominal focused assessment sonography for trauma

Exploratory laparotomy is surgery to open up the belly area (abdomen). This surgery is done to find the cause of problems (such as belly pain or bleeding) that testing could not diagnose. It is also used when an abdominal trauma needs emergency medical care. This surgery uses one large cut (incision). The provider can then see and check the organs inside the abdomen. If the cause of the problem is found during the procedure, then treatment is often done at the same time.

Abdominal trauma caused by blunt force is a common reason for exploratory laparotomy 0. The chief cause of blunt abdominal trauma is motor vehicle accidents. Other rare causes include falls from heights, bicycle injuries, injuries sustained during sporting activities, and industrial accidents. 

 Such accidents can cause damage to the internal organs, resulting in internal bleeding, contusions, or injuries to the bowel, spleen, liver,  and intestines. Patients can also present with extra-abdominal injuries such as extremity injuries. 

Because the presentation is often not straightforward, the diagnosis can be difficult and often time-consuming. Patient may present with bleeding per rectum, unstable vital signs, and the presence of peritonitis. The physical exam may reveal marks from a lap belt, ecchymosis, abdominal distention, absent bowel sounds and tenderness to palpation. If peritonitis is present, abdominal rigidity, guarding and rebound tenderness may be present. 

The mechanism of injury, motor vehicle speed, associated deaths at the scene, uses of alcohol or other substance of abuse must be taken into account so as not to miss an injury.

Under these circumstances, triage for exploratory laparotomy is some as following:
The diagnosis of intra-abdominal injury following blunt trauma depends primarily on the hemodynamic status of the patient. If the patient is hemodynamically stable, CT scan is the ideal test to look for solid organ injury in the abdomen and pelvis. For unstable patients, an ultrasound (Extended Focused Assessment with Sonography for Trauma (EFAST) is performed

The efficacy of focused assessment sonography is well backed up by the medical literature and the clinical community as a fast practical screening tool for exploratory laparotomy surgery triage at emergency departments.

Herein we highly recommend the FDA approved Color Double Head Wireless Ultrasound Scanner SIFULTRAS-5.42 for this purpose. The SIFULTRAS-5.42 has two heads, Thus making it more practical and more affordable than buying two separate single-headed probes. The Linear side of the Doppler allows you to evaluate the more superficial parts of the body while the Convex part is used for in-depth examinations ( A practical feature for multi trauma cases like abdominal blunt trauma).

This procedure is performed by a trauma surgeon. 

The utility of focused abdominal ultrasound in blunt abdominal trauma: a reappraisal
Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma


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