General

Emergency Laparotomy

OPERATION: Emergency Laparotomy
ANAESTHETIC: General anaesthesia — rapid sequence induction
ANTIBIOTICS: Broad-spectrum IV antibiotics including anaerobic cover at induction
POSITION: Supine. Urinary catheter. Nasogastric tube. VTE prophylaxis where feasible. Cell salvage available if major haemorrhage anticipated.

INDICATION:
[Peritonitis / hollow viscus perforation / bowel obstruction with ischaemia / mesenteric ischaemia / major abdominal haemorrhage / abdominal compartment syndrome]. Decision to operate made following clinical assessment, imaging [CT findings], and senior surgical review. NELA risk documented: [predicted mortality %]. Family / patient counselled regarding surgical risk. [ICU/HDU bed confirmed].

PROCEDURE:
WHO Checklist performed — modified for emergency. Abdomen prepared from nipples to groins and draped widely.

INCISION:
Midline laparotomy from xiphoid to pubis. Linea alba divided. Peritoneum entered. [Free blood / bilious fluid / faeculent peritoneal contamination / purulent fluid] encountered on entry — specimen sent for MC+S.

EXPLORATION:
Systematic laparoscopic survey performed: liver, gallbladder, spleen, stomach, duodenum, small bowel from duodenojejunal flexure to terminal ileum, appendix, caecum, ascending, transverse, descending and sigmoid colon, rectosigmoid junction, pelvic organs, retroperitoneum. [Describe findings].

SOURCE CONTROL / OPERATIVE FINDINGS AND MANAGEMENT:

[PERFORATED PEPTIC ULCER: Perforation identified at [anterior duodenal / gastric] surface. Graham patch repair performed — omental pedicle mobilised and sutured over defect with 2-0 absorbable sutures. Peritoneal cavity irrigated and aspirated.]

[PERFORATED COLON / DIVERTICULAR: Perforation at [sigmoid / left colon / caecum]. Bowel viability assessed proximally and distally. Hartmann's procedure performed — sigmoid divided with linear stapler; rectal stump oversewn; end colostomy fashioned in left iliac fossa.]

[SMALL BOWEL ISCHAEMIA: Ischaemic segment(s) identified — [length, location]. Resection performed with primary anastomosis / stapled ends left in discontinuity for second-look laparotomy. Superior mesenteric vessels assessed for thrombosis.]

[HAEMORRHAGE: Source identified as [vessel / organ]. Haemostasis achieved by [suture ligation / packing / vessel ligation]. [Damage control packing placed — abdomen left open for re-look at 48 hours].]

PERITONEAL IRRIGATION:
Peritoneal cavity copiously irrigated with warm saline until effluent clear. [Number] litres used. Residual fluid aspirated.

DRAINS:
[Closed suction drain placed in [location] / no drain].

CLOSURE:
[PRIMARY CLOSURE: Mass closure with loop 1-PDS continuous suture — Jenkins rule observed. Skin closed with staples.]
[OPEN ABDOMEN / DAMAGE CONTROL: Temporary abdominal closure with [Bogota bag / negative pressure wound therapy]. Patient transferred to ICU for resuscitation and planned return to theatre at 48 hours.]

FINDINGS:
[Detail: source of contamination, bowel viability, volume of peritoneal soiling, any other intraoperative findings].

SPECIMEN: [Resected bowel / perforated segment] to histopathology. Peritoneal fluid to microbiology.
EBL: [Volume] ml. COMPLICATIONS: [None / intraoperative — describe].

POST-OPERATIVE INSTRUCTIONS:
Level 2/3 care. Hourly observations. Nasogastric tube until bowel function returns. Regular review of drain output and stoma (if formed). Antibiotics continued as per microbiology guidance. Repeat laparotomy at 48 hours if damage control strategy employed.