An exploratory laparotomy (ex-lap) is the standard of care in various blunt and penetrating trauma situations in which there may be multiple life-threatening injuries, and in many diagnostic situations in which the operation is undertaken in search of a unifying cause for multiple signs and symptoms of disease.

The trauma ex-lap is the most comprehensive ex-lap, usually undertaken after evidence of internal bleeding (a positive FAST

Focused assessment with sonography for trauma

Focused Assessment with Sonography for Trauma is a rapid bedside ultrasound examination performed by surgeons and emergency physicians as a screening test for blood around the heart or abdominal organs after trauma.The four areas that are examined for free fluid are the perihepatic space...

, DPL

Diagnostic peritoneal lavage

Diagnostic peritoneal lavage is a procedure where, after application of local anesthesia, a vertical skin incision is made one third of the distance from the umbilicus to the pubic symphysis. The linea alba is divided and the peritoneum entered after it has been picked up to prevent bowel...

, or other overwhelming evidence for internal hemorrhage). A midline incision is carried down to the linea alba and the fascia is incised. The peritoneum is entered and any immediate, life-threatening bleeding is identified and controlled. The lateral, superior, and anterior surfaces of the liver

Liver

The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...

 are packed with sponges, and the superior and lateral spaces around the spleen

Spleen

The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...

 are similarly packed. The bowel is run from the ligament of Treitz to the terminal ileum

Terminal ileum

The terminal ileum is the most distal part of the small intestine. It connects to the cecum, the pouch between the small and the large intestine, via the ileocecal valve.-Pathology of the terminal ileum:...

. The gastrocolic ligament

Gastrocolic ligament

The gastrocolic ligament is a portion of the greater omentum that stretches from the greater curvature of the stomach to the transverse colon. It forms part of the anterior wall of the lesser sac....

 is incised and the lesser sac

Lesser sac

The lesser sac, also known as the omental bursa, is the cavity in the abdomen that is formed by the lesser and greater omentum. Usually found in mammals, it is connected with the greater sac via the epiploic foramen...

 is explored, including the posterior stomach

Stomach

The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...

 and the anterior pancreas

Pancreas

The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...

. The surface of the spleen

Spleen

The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...

 is examined for evidence of laceration and fracture. The liver is similarly examined. If necessary, Cattell and Mattox maneuvers may be performed to expose retroperitoneal structures. If the duodenum is at risk, a Kocher maneuver may be performed to examine the posterior duodenum

Duodenum

The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum...

 and the head of the pancreas.

The ex-lap can lead immediately to a number of other procedures, including splenectomy

Splenectomy

A splenectomy is a surgical procedure that partially or completely removes the spleen.-Indications:The spleen, similar in structure to a large lymph node, acts as a blood filter. Current knowledge of its purpose includes the removal of old red blood cells and platelets, and the detection and fight...

, repairs of the vena cava, repairs of the aorta

Aorta

The aorta is the largest artery in the body, originating from the left ventricle of the heart and extending down to the abdomen, where it branches off into two smaller arteries...

, distal pancreatectomy, enterotomy

Enterotomy

Enterotomy, by definition, is the surgical incision into an intestine. It may be a complication of an abdominal surgery including exploratory laparotomies....

 and bowel repair, left hemicolectomy, right hemicolectomy, pyloric exclusion, gastric diversion, partial or complete nephrectomy

Nephrectomy

Nephrectomy is the surgical removal of a kidney.-History:The first successful nephrectomy was performed by the German surgeon Gustav Simon on August 2, 1869 in Heidelberg. Simon practiced the operation beforehand in animal experiments...

, and the "trauma Whipple."