Organ-Specific Techniques

• Liver
• Spleen
• Abdominal vasculature
  
• Gastrointestinal tract
• Pancreas
• Lung

Damage Control Surgery

Overview
Metabolic failure
Damage control laparotomy
Organ-specific techniques
Critical Care
Abdominal Compartment Syndrome
Reoperation

Pancreas
Pancreatic injury rarely requires or allows definitive surgery in the damage control setting. Minor injuries not involving the duct (AAST I,II,IV) require no treatment. If possible a closed suction drain may be placed down to the injury, but this should not be done if the abdomen is packed and left open. If the injury is distal (to the superior mesenteric vein - AAST III) and there is extensive tissue destruction including the pancreatic duct, it may be possible to perform a rapid distal pancreatectomy.

Massive injuries to the pacreaticoduodenal complex (AAST V) are almost always associated with injuries to the surrounding structures. Patients will not survive complex operations such as pancreaticoduodenectomy. The pancreas should be debrided only. Small duodenal injuries can be repaired with a single layer suture, but large duodenal injuries should be debrided and the ends closed temporarily with suture or umbilical tape to be dealt with at the second procedure.

Critical Care