- Goals of damage control
- Rapid control of life-threatening bleeding
- Control of gastrointestinal contamination
- Avoid time-consuming definitive repairs
- Temporary closure and return to ICU for resuscitation
- Initial laparotomy
- Midline incision from xiphisternum to pubis
- Pack all four quadrants to identify bleeding source
- Suction blood and identify major sources of haemorrhage
- Bleeding control
- Temporarily control venous or parenchymal bleeding with packing
- Clamp, ligate or shunt major vessels if necessary
- Contamination control
- Staple or clamp perforated bowel ends to control spillage
- Resect non-viable segments without immediate anastomosis
- Leave bowel ends stapled or clipped for later anastomosis
- Abbreviated procedure
- Avoid complex repairs or reconstructions
- Only essential steps to control life-threatening issues are performed
- Consider intra-abdominal drains if needed
- Temporary abdominal closure
- Place a Laparostomy
- Leave the abdomen open to avoid abdominal compartment syndrome
- Postoperative care
- Transferto ICU for correction of acidosis, coagulopathy, and hypothermia
- Ongoing monitoring, ventilation, and resuscitation
- Plan for return to theatre (usually within 24–48 hours) for second-look laparotomy and definitive repair