With extensive damage to the bowel requiring resection, primary anastomosis is required. This may be time consuming and the integrity of the anastomosis is jeopardized in the milieu of generalized hypoperfusion. This may also make decisions about resection margins more difficult to judge.

In this case, especially with colonic injuries, or multiple small bowel lesions, it is wiser to resect non-viable bowel and close the ends, leaving them in the abdomen for anastomosis at the second procedure. The linear stapler is useful to achieve this, but bowel ends may be closed with running suture or even umbilical tapes. Ileostomies or colostomies should preferably not be performed in a damage control setting, especially if the abdomen is to be left open, as control of spillage is almost impossible.