Diagnostic laparotomy in the patient with multiple injuries

Seven hundred consecutive patients with multiple areas of injury requiring surgical repair outside of the abdomen were subjected to laparotomy. Five hundred sixty-one patients had intra-abdominal injury: 139 patients were found to have no intraperitoneal damage. The morbidity in the 139 patients with negative findings at laparotomy was 2%. In patients with multiple areas of trauma, the abdomen is almost always suspect. The proliferation of diagnostic tools to detect intraperitoneal damage have, in some ways, helped physicians decide as to laparotomy. However, when multiple injuries are present, particularly of the central nervous system, classical findings of peritoneal damage are difficult to elicit. A diagnostic laparotomy does not add significantly to the overall morbidity or mortality, and in 25% of the patients in whom intraperitoneal pathology was not strongly suspected, damage requiring surgery was found. We think there is still a place for diagnostic laparotomy in patients with multiple trauma.