General

Exploratory Laparotomy

EXPLORATORY LAPAROTOMY

Indication: Acute abdomen requiring surgical exploration when imaging is inconclusive or clinical findings demand urgent operative assessment — peritonitis, suspected perforation, ischaemic bowel, or uncontrolled haemorrhage.

Patient Position: Supine.

Anaesthesia: General.

Prophylactic Antibiotics: Broad-spectrum cover for Gram-negative organisms and anaerobes.

Incision: Midline laparotomy (standard access for most acute abdominal pathology).

Procedure:
1. Rapid midline incision through skin, linea alba, and peritoneum.
2. Systematic exploration of the peritoneal cavity:
   - Free fluid or blood: aspirated and sent for culture/cytology.
   - Liver: palpated for masses.
   - Gallbladder and biliary tract inspected.
   - Stomach, duodenum, and small bowel: inspected sequentially from the Treitz ligament to the ileocaecal junction.
   - Large bowel: inspected from caecum to rectosigmoid.
   - Appendix: inspected.
   - Pelvis: examined in female patients for gynaecological pathology.
   - Retroperitoneum: palpated for aortic pathology.
3. Pathology identified and managed definitively or with damage-control approach as appropriate.
4. Peritoneal lavage if contamination present.
5. Wound closed in layers. Drain placed if required.

Finding(s): [Peritoneal contamination: nil / bilious / purulent / faeculent. Free blood: nil / __ mL — source identified: specify. Pathology identified: specify. Procedure performed: specify.]

Complications Noted: [None / specify.]

Postoperative Instructions: As per underlying pathology managed. Enhanced recovery where appropriate.