Complications of negative laparotomy for trauma.

Controversy continues about how often a negative laparotomy should be accepted in the management of patients with blunt and penetrating trauma. A key issue is the complications, especially small bowel obstruction. To define these complications, the charts of 248 patients who underwent negative laparotomy for trauma were examined. There were 185 patients with penetrating injuries and 63 with blunt injuries. Associated injuries were present in 119 patients. Acute perioperative morbidity occurred in 53 percent of the patients with associated injuries and 22 percent of patients with no associated injuries. On long-term follow-up, five patients developed small bowel obstructions. The incidence of small bowel obstruction was related to operative exposure. We have concluded that early morbidity after a negative laparotomy is more common when associated injuries are present. The risk of postoperative small bowel obstruction is small, especially when extensive operative dissection is not necessary. Abdominal exploration should not be discarded as a viable diagnostic and therapeutic procedure in patients with equivocal findings.