Chips from a surgeon's workshop : five consecutive cases of gunshot wounds of the abdominal viscera treated by abdominal section : two deaths, three recoveries / by A.C. Bernays.

  • Bernays, Augustus Charles, 1854-1907.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Chips from a surgeon's workshop : five consecutive cases of gunshot wounds of the abdominal viscera treated by abdominal section : two deaths, three recoveries / by A.C. Bernays. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    8/32 (page 4)
    The three shot had evidently separated from one another in? their course and three perforations were found in the begin- ning of the ascending colon on its anterior aspect about one and one-half inches above the ileo-csecal valve, two of them stopped in some rather hard faecal matter, one passed through and perforated the posterior wall where it lodged between the layers of the mesocolon. This shot must have cut or torn a small artery and had given rise to the formation of a hsemat- oma as large as a small egg. The hsematoma did not increase in size during the operation and since it was confined between the layers of the mesocolon I left it undisturbed. This, I think was a mistake, because 1 should have reasoned that the shot in passing through the scybalum probably carried with it some of the faecal matter which, together with the bullet, would give rise to some form of inflammation. The noxious* substance clearly was extraperitoneal but in such close prox- imity to the peritoneal lymph sac, that peritonitis might be set up by contiguity. This form of peritonitis is similar to a form which has been described under the name of intestino- peritoneal septicaemia, which leads to death in a mannei quite different from the ordinary tempestuous acute peritonitis. The infection of the peritoneum seems to be a more gradual one, the spreading of the process over the membrane goes on more slowly, involving only limited areas. Death usually takes place before the whole of the peritoneum is affected. I have seen this pathological process in case of typhlitis, also in one case of tuberculosis of the intestines where a perfora- tion had not taken place. The symptoms of this form of peritonitis were well marked in my case and will be described below. The three holes in the anterior wall of the colon bled free- ly and some faecal particles had escaped. The colon was tightly contracted around the scybala and the torn edges of the mucosa were projecting through the muscular and serous coats. The three holes were almost in a straight line along the colon and were within the space of one inch and a quai- ter. They were closed by ten interrupted Lembert sutures. The finest iron-dyed silk was used. The blood was carelully sponged away and the external wound closed by eight deep and twelve superficial sutures. An antiseptic dressing wa& applied.