# Exploratory laparotomy

- Link: https://sifsof.com/clinical-apps/exploratory-laparotomy/
- Published: 2021-08-22T17:58:27+00:00
- Author: Monica

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
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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. 

Reference: 
[The utility of focused abdominal ultrasound in blunt abdominal trauma: a reappraisal](https://pubmed.ncbi.nlm.nih.gov/18005762/)
[Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma](https://pubmed.ncbi.nlm.nih.gov/26368505/)

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