General Surgery · Upper GI

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.

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