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Eleven Perforations of the Intestine Gunshot Wound of the Abdomen



Presented is a colored man, aged thirty-three years, who was admitted to the Roosevelt Hospital, shortly after mid night in May last, suffering from a gunshot wound of the abdomen. It was learned that he had been shot about one hour before by a companion, with a 32-calibre revolver, at close range. On examination, his pulse was 130, temperature ioo.8° F., respiration 30. Evidences of haemorrhage, with moderate shock. The wound of entrance was seen one inch to the right of the umbilicus. There was no distention, but the evidences of free fluid in the abdominal cavity were present.

He was immediately prepared for operation. Under ether anaesthesia, an incision about fifteen inches in length was made just to the right of the median line. On opening the abdominal cavity, a large amount of free blood, mixed with intestinal con tents, escaped. Numerous coils of small intestine immediately presented, showing a number of perforations. These were su tured with fine black silk as they presented, after which the small intestine was withdrawn and other wounds found, which were similarly sutured. In two places, about eighteen inches apart, the intestine and its mesentery were so injured that resection had to be performed. This was done ; about three or four inches of intestine, with a V-shaped portion of mesentery, were removed in both instances, and the intestinal wounds united with two Murphy buttons. The entire small intestine was then removed from the abdomen and carefully inspected, also the large intes tine and stomach. A very large amount of clotted blood was present in the pelvis and in both flanks. This was removed with large gauze sponges, and the entire cavity of the abdomen irri gated with hot salt solution.

During these manipulations, the condition of the patient be came extremely critical ; and, after vigorous hypodermic stimu lation, a large infusion of hot salt solution was made into the median cephalic vein. He was removed from the table in a con dition of profound shock, and shortly afterwards another large saline infusion was given.

Vomiting of faecal matter occurred, continuing more or less for two days, and was finally relieved by frequent stomach lavage. At the end of this time the vomiting ceased, and he began to show substantial improvement. The bowels were moved on the third day, and the pulse and temperature fell to normal on the sixth day. The first button passed on the ninth day ; the second, on the fifty-fifth day, and the abdominal wound united by first intention.

DR. HOWARD LILIENTHAL said the case recalled an article he had read upon the subject of gunshot wounds of the abdomen in negroes. In this article, which was written by a Southern surgeon whose name he had forgotten, the writer stated that the percentage of deaths after gunshot wounds of the abdomen was lower among the colored race than among the white. His ex planation for this was that when the negro is well fed he remains lethargic and peaceable, whereas, when he is hungry, lie is more apt to become quarrelsome ; and if he is shot in the abdomen. his intestines are empty, and his chances of recovery are better than those of a man whose intestines are perforated when they are filled with food. It appears that in Dr. Brewer's in spite of the numerous perforations, very little intestinal material escaped.

DR. GEORGE WOOLSEY said that Dr. Lilienthal's remarks re minded him of a case of gunshot wound of the abdomen in a white man which he presented to the Society a few years ago. In that case there were sixteen perforations of the gut; four of them were so. close together that it was necessary to excise a portion of the intestine, as Dr. Brewer had done in his case. Dr. Woolsey said that his patient had eaten no food for twenty-four hours at the time he was shot, and the intestines were practically empty. To this fact, the speaker said, he had partly attributed the patient's recovery from the operation. Another important factor in these cases is the personal equation, some persons being much less liable to infection than others.

day, wounds, removed, intestines, abdominal, cavity and inches