Ex-lap
Formal Definition
Exploratory laparotomy: a surgical procedure involving a large abdominal incision to directly examine the abdominal and pelvic organs when imaging or clinical assessment is insufficient to determine the source of pathology — often performed as an emergency procedure for suspected intra-abdominal catastrophe.
How It's Used on the Ward
"Going to ex-lap" or "needs an ex-lap" — the decision that the abdomen needs to be opened urgently without waiting for more workup.
Example
""Trauma activation: stab wound to the abdomen, peritoneal signs, BP dropping despite resuscitation. Attending: 'No time for CT. This is a dirty belly. Take him to ex-lap now.' Open left colon injury found — damage control surgery performed.""
Clinical Context
Exploratory laparotomy is the decision that clinical uncertainty ends at the operating table. Indications: unstable patient with penetrating abdominal trauma, bowel perforation with free air, ischemic bowel, uncontrolled intra-abdominal hemorrhage, or a peritoneal exam that clearly indicates a surgical abdomen. CT helps plan; when time doesn't permit or the diagnosis is certain by exam, the OR is the right next step. Damage control surgery (abbreviated procedure to stop bleeding and contamination, followed by ICU stabilization and re-look laparotomy) is the paradigm for hemodynamically unstable patients.
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