We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

Avoidance of Abdominal Compartment Syndrome in Damage-Control Laparotomy After Trauma—Invited Critique

H. Harlan Stone, MD
Arch Surg. 2001;136(6):681. doi:10.1001/archsurg.136.6.681.
Text Size: A A A
Published online


This review of a 5-year experience with damage-control laparotomy by Offner et al provides concisely recorded data for thoughtful reflection. The results are quite good, yet I fear that avoidance of compartment syndrome at all costs is not an appropriate goal for many cases.

If, during initial exploration, the freshly shed blood clots and there is no ongoing complicating coagulopathy, then clearly the abdomen should be closed without such undo tension as would create a compartment syndrome and its attendant difficulties, ie, acute respiratory distress and/or multiple organ failure. Abdominal closure can thereby be selective and may be based on fascial approximation, mere skin closure, or insertion of some prosthesis, with overlying skin left either open or closed. However, if coagulopathy is overt, only the tamponading effect of an abdomen closed under tension can allay further massive bleeding, can obviate the need for infusion of even greater amounts of blood than would otherwise be required, and thus can permit a more rapid correction of the clotting disorder.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles