Emergency laparotomy in multiply injured patients.

The records of 146 consecutive multiply injured patients treated between 1976 and 1981 have been studied. Thirty-five patients underwent emergency laparotomy and in 24 patients the laparotomy was done 4 or more hours after admission. Eight of the 35 patients of the third group died, in 4 of whom the cause was head injury. The other 4 patients were extremely severely injured (Injury Severity Scores from 66 to 75). In the second group, 6 patients died, 5 from multi-organ failure due to sepsis and 1 patient from hypovolaemic shock. The more aggressive approach--to prevent multi-organ failure--is advised. The laparotomy, if indicated, must be done as an emergency procedure. During the same procedure fractures can be stabilized. In the postoperative period, mechanical ventilation should be instituted. Fresh blood should be given when more than 4000 ml stored blood is transfused, to prevent any tendency to bleed.