A sensitive way to evaluate for intra-abdominal injury in the trauma patient

 In Blunt Trauma

    Unexplained hypotension

    Concern for injury but no obvious indication for laparotomy and serial abdominal examinations are not practical (i.e., unconscious or under anesthesia)

    Equivocal focused abdominal sonography for trauma (FAST) examination and concern for an intra-abdominal injury

    Patient unsuitable for computed tomography (CT) in whom there is concern for intra-abdominal injury

    Concern for mesenteric or hollow viscous injury not seen on CT

 In Penetrating Trauma

    Anterior abdominal stab wound and evidence of fascial penetration in the stable patient with no obvious indication for laparotomy

    To evaluate for hollow organ or diaphragmatic injury in the stable patient

CONTRAINDICATIONS

 Absolute Contraindications

    Indication for an emergent laparotomy

 Relative Contraindications

    Prior abdominal surgery

    Second or third trimester of pregnancy—consider open technique with supraumbilical approach

    Morbid obesity

    Significant ascites

    Coagulopathy

LANDMARKS

The incision should be made in the midline, one-third of the way between the umbilicus and pubic symphysis. In the pregnant patient or the patient with a pelvic fracture, the incision should be made in the midline, just above the umbilicus (FIGURE 16.1).

SUPPLIES

 1% Lidocaine with epinephrine, 20 mL with 25-gauge needle, 10-mL syringe

 Sterile towels or drapes, sterile gown and gloves, mask, and eye protection

 Povidone–iodine (Betadine) solution or chlorhexidine

 11-Blade scalpel

 Syringe and needle (for closed technique)

 Flexible guidewire (for closed technique)

 Two clamps and two retractors (for open technique)

 Peritoneal catheter

 1 L warm saline for infusion (for lavage)

 Tubing to let lavage fluid drain

 Suture (for open technique)

TECHNIQUE

 Preparation

    Place a Foley catheter (unless contraindicated)

    Place a nasogastric tube (unless contraindicated) to suction to decompress the stomach

    Gather all instruments and sterile gown/gloves

    Sterilize the abdomen from costal margin to pubis and from flank to flank with povidone–iodine solution (Betadine) or chlorhexidine

    Drape the area with sterile towels or drapes

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