**3. Surgical consultation**

**2.7. Emergency (exploratory) laparotomy**

**Table 1.** Criteria for evaluation of peritoneal lavage fluid.

20 mL gross blood on free aspiration (10 mL in children)

≥500 white cells/μL (if obtained 3 h or more after injury)

Bile (by inspection or chemical determination of bilirubin content)

ally from the presence of retroperitoneal blood.

gency laparotomy [8].

**Positive**

80 Trauma Surgery

≥100,000 red cells/μL

≥175 units amylase/dL

Food particles **Intermediate**

**Negative** Clear aspirate ≤100 white cells/μL ≤75 units amylase/dL

Bacteria on Gram-stained smear

Pink fluid on free aspiration

100–500 white cells/μL 75–175 units amylase/dL

50,000–100,000 red cells/μL in blunt trauma

Most patients with penetrating abdominal injuries will also require laparotomy given the high incidence of intra-abdominal injury once the fascia has been violated. Hemodynamically unstable patients sustaining blunt or penetrating trauma with a positive screening test [such as focused assessment with sonography for trauma (FAST) examination or diagnostic peritoneal lavage (DPL)] require laparotomy to control hemorrhage and evaluate for intra-abdominal injuries. Also patients with obvious diaphragmatic injury noted on chest X-ray require emer-

The tree main indications for exploration of the abdomen following blunt trauma are peritonitis, unexplained hypovolemia, and the presence of other injuries known to be frequently associated with intra-abdominal injuries. Peritonitis after blunt abdominal trauma is rare but always requires exploration. Signs of peritonitis can arise from rupture of a hollow organ, such as the duodenum, bladder, intestine, or gallbladder from pancreatic injury, or occasion-

Emergency abdominal exploration should be considered for patients with profound hypovolemic shock and a normal chest X-ray unless extra-abdominal blood loss is sufficient to account for the hypovolemia. In most cases a rapidly performed FAST examination or peritoneal lavage will confirm the diagnosis of intraperitoneal hemorrhage. Patients with blunt trauma and hypovolemia should be examined first for intra-abdominal bleeding even if there is no overt evidence of abdominal trauma. Hemoperitoneum may present with no Seek surgical consultation early in the management of patients with abdominal trauma, especially if the patient is hemodynamically unstable [9].
