Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum

Purpose: Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum.The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown.methods: In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015.Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL.After applying those criteria, 62 patients were enrolled in this retrospective review.PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy.results: The mean estimated hemoperitoneum was 3,516 mL.The incidence of PLH was 23% (14 of 62 patients).The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8mmHg; p=0.193).The overall in-hospital mortality was 24% (15 of 62 patients).Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33).No statistically significant between-group differences were observed in the intensive care unit and hospital stay.Conclusions: PLH may be less frequent and less devastating than it is often considered.Surgical hemostasis during laparotomy is important.Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.