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Damage control surgery: use of diagnostic CT after life-saving laparotomy

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Abstract

Damage control surgery (DCS) is a limited exploratory laparotomy that is performed in unstable trauma patients who, without immediate intervention, would acutely decompensate. Patients usually present with shock physiology and metabolic derangements including acidosis, hypothermia, and coagulopathy. Delayed medical correction of these metabolic derangements leads to an irreversible state of coagulopathic hemorrhagic shock and inevitable patient demise. Therefore, once a patient meets DCS criteria, a limited exploratory laparotomy is performed to stabilize life-threatening injury and expedite initiation of medical resuscitation in the intensive care unit (ICU). The surgeon plans to return to the operating room for definitive surgical treatment once the patient is hemodynamically stabilized and the metabolic derangements have been corrected. DCS patients are frequently sent to the ICU with an open abdomen and purposefully retained surgical equipment. The lack of response to resuscitation efforts, persistent hypotension, tachycardia, and/or the development of sepsis are common indications for this patient population to undergo CT imaging. The indications and findings of multi-detector CT (MDCT) in patients post-DCS have not been thoroughly evaluated in the radiology literature. A radiologist’s knowledge of the DCS protocol and pre-imaging surgical interventions helps optimize the MDCT protocol. This enhances the radiologist’s ability to evaluate for failure of surgical interventions performed prior to imaging and to search for injuries in areas that were not explored or that were missed during the initial surgical exploration.

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Acknowledgements

Jaques McGruff for the medical illustrations provided in this publication.

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Authors and Affiliations

  1. Department of Radiology, Boston University Medical Center, 820 Harrison Avenue 3rd Floor, Boston, MA, 02118, USA

    Armonde A. Baghdanian, Arthur H. Baghdanian, Maria Khalid, Anthony Armetta, Christina A. LeBedis, Stephan W. Anderson & Jorge A. Soto

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  1. Armonde A. Baghdanian
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  2. Arthur H. Baghdanian
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  3. Maria Khalid
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  4. Anthony Armetta
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  5. Christina A. LeBedis
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  7. Jorge A. Soto
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Correspondence to Armonde A. Baghdanian.

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Certificate of Merit at the ASER Scientific Meeting in Key Biscayne, Florida in 2015.

Summary statement

A conceptual understanding of damage control surgery (DCS) and its common imaging presentations is essential for optimizing MDCT scan protocols and providing accurate interpretations.

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Baghdanian, A.A., Baghdanian, A.H., Khalid, M. et al. Damage control surgery: use of diagnostic CT after life-saving laparotomy. Emerg Radiol 23, 483–495 (2016). https://doi.org/10.1007/s10140-016-1400-7

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  • DOI: https://doi.org/10.1007/s10140-016-1400-7

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