The damage control concept represents an extension of modern trauma resuscitation into the operating room. This surgical concept has found its most versatile and important use in severe abdominal trauma. The two critical concerns during damage control laparotomy are achieving hemostasis and preventing uncontrolled spillage of intestinal contents or urine. All else is secondary, and contrary to the traditional sequence of abdominal surgery, it is also deliberately disregarded. The common denominator of the many techniques presented in this article for a bail-out laparotomy is the need for a rapid decision, creative improvisation, and awareness that the outcome is determined by the patient's physiologic envelope and not by anatomic integrity, which can be achieved at reoperation.