Laparotomy is the "gold standard" therapy for intraabdominal injuries. As mentioned previously, it is definitive and rarely misses an injury. It allows for complete evaluation of virtually all structures within the abdomen and the retroperitoneum at a single point in time. Laparotomy may be exploratory in nature or may be performed to treat a diagnosed injury.
Indications for surgical abdominal exploration vary from institution to institution depending on location, expertise, and interest. Table 252:2 describes generally accepted indications for exploratory laparotomy. Certainly all patients with hypotension, abdominal wall disruption, or peritonitis mandate surgical exploration. In addition, the presence of extraluminal, intraabdominal, or retroperitoneal air either on plain film or CT should prompt surgical exploration. Finally, organ-specific diagnosis on CT often will mandate exploration. Examples include pancreatic injury, duodenal injury, renal injury with urinary extravasation outside Gerota's fascia, or a small bowel or colon injury.
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