Case Analysis of
Exploratory Laparotomy
(Ex-Lap)
Submitted by:
Tuppal, Krizzea Anne A.
BSN4-NDC5
Submitted to:
Mrs. Chariz Hazel Anne, RN
TABLE OF CONTENTS
Chapter I: Introduction………………………………………………………………………4
Chapter II: Patient’s History and Background……………………………………………. .10
Chapter III: Presenting Signs and Symptoms………………………………..…………… .12
Chapter IV: Initial Assessment and Diagnostic Tests………………………………………17
Chapter V: Pathophysiology of the Disease……………………………………………….22
Chapter VI: Laboratory Results……………………………………………………………25
Chapter VII: Nursing and Medical Management…………………………………………26
a. List of Identified Problems
b. Prioritization
c. Nursing Care Plan
d. Drug Study
Chapter VIII: Summary and Conclusion……………………………………………………39
INTRODUCTION
This case study focuses on Patient X, a 55 year-old male diagnosed with Gastric Ulcer
Disease with Peritoneal Contamination. Patient X was admitted to the hospital on
March 31, 2025 and received care from student nurses and the medical team. Prior to
admission, Patient X experienced sudden severe abdominal pain and showed signs of
peritonitis to which the patient had undergone an exploratory laparotomy where they
found a perforated ulcer with peritoneal contamination. The patient received palliative
care management within the shift and his stay in the facility.
Exploratory Laparotomy is a medical procedure performed with the objective of
obtaining information that is not available via clinical diagnostic methods. It is
usually performed in patients with acute or unexplained abdominal pain, in patients
who have sustained abdominal trauma, and occasionally for staging in patients with a
malignancy.
Common indications for performing an exploratory laparotomy include Acute and
Chronic Abdominal Pain, Abdominal Trauma, Obscure Gastrointestinal Bleeding,
Staging of Ovarian Malignancy and Hodgkin Disease, Peritonitis, Ectopic Pregnancy,
Post Operative Complications and Infections.
The management of a perforated viscus begins with rapid assessment and stabilization.
Patients often present with signs of shock, such as hypotension and tachycardia, due
to fluid loss or septic shock. Initial treatment includes fluid resuscitation with IV
fluids to restore volume and maintain blood pressure, along with pain management
using analgesics and oxygen therapy to ensure adequate oxygenation. Vital signs are
closely monitored, and imaging studies help confirm the diagnosis. Laboratory tests
assess infection severity and organ function. Broad-spectrum antibiotics are
administered immediately to cover both aerobic and anaerobic organisms, and
treatment is adjusted based on culture results.
Surgical intervention is essential, with laparotomy being the typical approach for
urgent cases. If the perforation is small and localized, laparoscopy may be used. The
surgeon repairs the perforation, often with primary closure or an omentum patch in
cases like gastric perforation. For extensive damage, bowel resection or diversion may
be required. Peritoneal lavage is performed to irrigate the abdomen, and drains may
be placed to prevent fluid accumulation and infection.
After surgery for a perforated viscus, the patient requires close monitoring for
complications such as infection, abscess formation, or sepsis. Critical patients may be
transferred to the ICU for intensive surveillance, especially if they need mechanical
ventilation or vasopressor support. Postoperative antibiotic therapy continues for
several days or weeks, tailored to the patient's condition and culture results.
Nutritional support is essential, with early enteral feeding encouraged if possible, or
parenteral nutrition if bowel function is delayed. Continuous monitoring of fluid and
electrolyte balance is crucial, as imbalances are common in the recovery period,
particularly after bowel resections or in septic patients.
Patient Information:

Name: Patient X

Age: 55 years old

Sex: Male

Medical History: A history of Peptic Ulcer Disease
Chief Complaint: Sudden severe abdominal pain and signs of peritonitis
PATIENT’S HISTORY & BACKGROUND
Patient X has a history of Peptic Ulcer Disease to which he has not properly managed
by not modifying his lifestyle. Patient’s previous medications are Proton Pump
Inhibotors, H2 Blockers, Antacids which he uses to reduce his gastric acid production.
Antibiotic Therapy for H. pylori eradication and discontinuation of NSAIDs or other
medications that may exacerbate ulcers.
PRESENTING SIGNS AND SYMPTOMS
Patient X’s vital gigns are as follows which his is BP= 90/50 PR= 128 bpm RR= 28
bpm and SPO2= 95%. The patient experienced sudden onset of severe and sharp
abdominal pain and showed signs of peritonitis. Patient X described pain as stabbing
or burning and the worst pain he has ever experienced. Pain radiates to the back, right
shoulder, and chest. Pain also increases with movement, coughing, and deep breathing.
Upon assessment, Patient’s abdominal muscles is tense and rigid which is commonly
known as "board-like" abdomen. Tenderness increases when the abdomen is pressed
and released. Patient also experienced nausea and vomiting.
INITIAL ASSESSMENT & DIAGNOSTIC TESTS
Diagnostic/Laboratory Findings:
a. Contrast-Enhanced CT Scan revealed a gas within the abdominal wall. There is
also a presence of abscess in the peritoneal cavity.
b. Complete Blood Count revealed elavated WBC count (leukocytosis) and low
levels of Hemoglobin and Hematocrit.
c. Arterial Blood Gas reveal Metabolic Acidosis as the pH is low and low
bicarbonate level.



Pain Level: Using Pain Scale, Patient X rated his pain 9 out of 10.
Vital Signs: BP= 90/50 PR= 128 bpm RR= 28 bpm SPO2= 95%
PATHOPHYSIOLOGY
NURSING CARE PLAN
Acute Pain
Imbalance Fluid Volume
Risk for Infection
DRUG STUDY
Pip Taz
Omeprazole
Morphine
Ranitidine
CONCLUSION AND REFLECTION
VI. Nursing Care Plan (NCP)
a. List of problems
b. Prioritized problems
c. NCP (2 actual, 1 risk)