Exploratory laparotomy as a diagnostic and therapeutic modality is clearly indicated in trauma patients if penetrating trauma is highly suspected or known, or if the patient‘s status deteriorates despite aggressive resuscitation attempts and major organ hemorrhage or injury is suspected or known.13
- Non-invasive diagnostic imaging is recommended in an attempt to confirm a suspicion of major internal organ injury. Perform AFAST, abdominocentesis, and/or DPL as necessary, and advanced imaging if available.
- Patients with penetrating abdominal injuries and a high index of suspicion for peritonitis, bowel injury, ruptured viscus, major hemorrhage, or other life-threatening problem need emergent surgery to further define the extent of injury and provide corrective surgery. There may be instances in which emergent laparatomy is necessary by HCPs to afford a chance at patient survival. See Emergent Abdominal Laparotomy in this CPG for guidance. Empiric antibiotic therapy is critical (See Table 11 above).