Which of the following statement(s) concerning the operative approach to abdominal trauma is/are correct?

b. Central retroperitoneal hematomas should be explored after control of other injuries within the peritoneal cavity

d. The initial approach is control of hemorrhage by packing and controlling ongoing contamination from enteric injuries

Once the abdomen is opened at laparotomy for trauma, obvious blood and clot is sequentially removed, first from the lower abdomen and then from the upper abdomen by packing all four quadrants of the abdomen. Any areas found to be a source of hemorrhage can be repacked. Obvious hollow viscus wounds should be rapidly sutured or controlled with noncrushing clamps. Once hemorrhage is controlled by packing and ongoing contamination is stopped, time is then taken to allow resuscitation of the patient’s circulating blood volume. Retroperitoneal hematomas may be the source of exsanguinated hemorrhage if rupture into the free peritoneal cavity has occurred. If not, these can be left for investigation at a later time, depending on the location. Hematomas of the pelvis that are associated with pelvic fractures should not be disturbed. Similarly, stable hematomas of the perinephric space lateral to the midline are also best left undisturbed. Central hematomas that may involve injuries to the major vascular structures, pancreas or duodenum are noted and explored after control of injuries within the peritoneal cavity.