Reoperation after abdominal trauma.

A five year experience with 782 patients requiring laparotomy for trauma is reviewed. Specifically, the 70 patients requiring unplanned reexploration have been studied to delineate the indications for and implications of such repeat laparotomies. The major indications for such reoperation were intraabdominal abscess (45.7 per cent), bleeding (15.5 per cent), peritonitis (12.1 per cent), and small bowel obstruction (8.6 per cent). There were 16 negative reexplorations (13.8 per cent). Overall mortality in the reexplored patients was 21.4 per cent, all victims of gunshot or blunt trauma. Mortality correlated with the number of required reexplorations, being 67 per cent in those requiring four operations. Of the 31 laparotomies performed initially for diffuse or localized intraabdominal sepsis, only 15 were highly suspected, and 13 of these by simple chest x-ray findings. If after laparotomy for repair of intraabdominal trauma a patient fails to meet the anticipated norm of convalescence, a high index of suspicion for early postoperative hemorrhage, or later sepsis, should be maintained. Such patients have far more to gain than lose by reexploration.