Two cases of gunshot wound of the abdomen : illustrating the use of rectal insufflation with hydrogen gas as a diagnostic measure / by N. Senn.

  • Senn, Nicholas, 1844-1908.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Two cases of gunshot wound of the abdomen : illustrating the use of rectal insufflation with hydrogen gas as a diagnostic measure / by N. Senn. 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.

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    undressing him, a bullet wound, with omentum protruding, was found two inches to the right of the middle line, and on a level with the anterior supe- rior spine of the ileum. Left iliac region dull on percussion; and in right, a cracked-pot sound was elicited on percussion. A rectal enema was admin- istered, and was followed by a free fecal discharge, without admixture of blood. (On washing the feces afterward the bullet was found.) Operation.—Ether, as an anaesthetic; thorough disinfection of abdominal wall; rectal insufflation of hydrogen gas, followed by the escape of bubbles of the gas, within a few seconds, at the wound of en- trance, into which had been placed a haemostatic forceps, the blades separated so as to render the canal patent. The gas was lighted, and after thor- ough cauterization of the wound by the flame, the flame was extinguished by the application of a wet sponge. Laparotomy by median incision, eight inches in length, from pubes upward. About a pint of fluid blood in the peritoneal cavity, and hemorrhage continuing from the mesenteric veins at two points of perforation on the mesenteric side of the bowel, and to a less extent from perforations of the mesen- tery ; arrested by ligating en masse. Within a dis- tance of four feet, near the middle of the ileum, were found ten perforations, two of which were at the mesenteric border; also four perforations of the mesentery. Another perforation of the bowel was found within four inches of the ileo-csecal valve on the convex side of the intestine, making so far eleven in all. All were closed by Czerny-Lembert sutures. At two points the perforations were so close together that it was found necessary to invert half the circum-