Patients typically enter the intensive care unit (ICU) with an open abdomen following trauma “damage control” surgery or treatment or prevention of abdominal compartment syndrome. Damage control surgery is performed when excessive bleeding results in the lethal triad of acidosis, hypothermia, and coagulopathy. Obtaining control of bleeding in the operating room usually involves packing and occasionally the use of balloon occlusion catheters. Surgery is terminated before the completion of the procedure in order to return the patient to the ICU. This ICU resuscitation phase of rewarming and reversal of coagulopathy is referred to as the second phase of damage control surgery. On return to the ICU, resuscitation will only be successful if both medical and surgical bleeding has been adequately controlled.

In general, inability to correct hypothermia, acidosis, and coagulopathy with ongoing requirement for transfusion indicates the presence of ongoing surgical bleeding. Reexploration and repacking may be attempted, even in the ICU. Consideration of angiographic embolization or placement of balloon occlusion catheters is appropriate in certain cases.

Embolization represents an acceptable primary form of therapy in many solid-organ injuries in which the goal is to avoid laparotomy and/or loss of an organ. In addition, for high-grade liver injury, bleeding pelvic fracture, and retroperitoneal bleeding, embolization reduces the overall blood loss associated with a more invasive operative approach that interrupts the compressive effects of natural tissue planes. Once the abdomen is open, in the setting of phase II damage control, the role of angiography is more specific.