A patient presents with a pelvic fracture and a positive diagnostic peritoneal lavage (DPL). What is the recommended first surgical intervention?

In the case of a patient presenting with a pelvic fracture and a positive diagnostic peritoneal lavage (DPL), the recommended first surgical intervention is laparotomy. This approach is preferred because a positive DPL indicates the presence of intra-abdominal hemorrhage or injury, which warrants exploration to identify and control the source of bleeding.

Laparotomy allows for direct evaluation and management of any visceral injuries, as well as addressing any significant hemorrhage that may be contributing to the patient's instability. In cases of trauma, particularly with suspected intra-abdominal injuries, the priority is often to provide immediate access to the abdominal cavity for diagnosis and potential surgical repair.

Other options such as laparoscopy may not provide the necessary access or speed required in trauma situations, especially when there is significant bleeding that needs to be addressed promptly. Angioembolization, while useful in managing pelvic hemorrhages, is usually considered after initial stabilization and control through surgical intervention. Internal fixation is relevant for stabilizing pelvic fractures but is not the immediate priority in the presence of an ongoing hemorrhage or intra-abdominal injury, where direct surgical intervention is essential.