WOUNDS OF THE ABDOMEN. 71 



WOUNDS OF THE ABDOMEN. 



Wounds of the abdomen are extremely dangerous, on account of 

 the important viscera contained within, and the liability to peritonitis. 

 A simple wound of the parietes must be closed by suture if it is exten- 

 sive, care being taken not to include a portion of the intestine. When 

 complicated with a wound of the liver, fatal hemorrhage must almost 

 necessarily result, on account of the great vascularity of the organ. 

 A patient may survive a small wound, which will be succeeded by 

 great prostration, pain in the liver, yellowness of the skin and urine, 

 and a bilious discharge of the wound. 



The u-ou7ids of the gall bladder, and spleen, and urinary bladder, 

 •if communicating with the peritoneum, are almost always fatal. 

 Wounds of the kidney are also exceedingly dangerous from hemor- 

 rhage, violent inflammation, and suppuration, with excessive vomit- 

 ing. Venesection, laxatives, warm bath, avoidance of drinks, with 

 hght dressings of the wound, are the proper measures for treatment. 



Protrusion of the Bowel. — When a portion of the intestine pro- 

 trudes through a parietal wound of the abdomen, it is to be returned 

 with great gentleness and accuracy, so as to avoid inflammation and 

 obscure strangulation. The edges of the wound are to be carefully 

 approximated, by suture if necessary, and by moderate bandaging 

 such pressure is to be made as to prevent reprotrusion. 



Wound of the Bowel. — A wound of the bowel may be suspected 

 from the passage of blood with the stools, the escape of fseces through 

 the wound, excruciating pain over the whole belly, and a great ten- 

 dency to collapse. 



Extravasation into the cavity of the peritoneum does not take 

 place from a small wound, owing to the protrusion of the mucous 

 coat through the muscular, and the constant and equable pressure 

 of all the abdominal viscera ; lymph is also rapidly effused, and the 

 contiguous eages are thus united. If, therefore, the protruded part 

 be found to have sustained a mere puncture, it is to be returned as 

 if entire. A small incision may be closed by the glover's suture ; the 

 ends are cut short, and the exudation of lymph envelopes the 

 thread, which in time finds its way into the cavity of the bowel, and 

 is thence discharged. 



If the portion of bowel be bruised and lacerated to such an extent 

 as to render adhesion impossible, and gangrene probable, the wounded 

 part must be retained at the surface, and the peritoneal coat united 

 with the integuments at one or more points ; the fseces are thus dis- 

 charged through the external wound, and an artificial anus is thus 

 established. 



Wounds of the stomach are recognised by vomiting of blood, and 

 the nature of the matters which may escape from the wound. They 

 are much more dangerous than those of the bowel. The edges of 

 the stomach and the edges of the external wound are to be stitched 



