PENETRATING WOUNDS OF THE ABDOMEN. 511 



from the appearance of the body producing the wound. The probe 

 should not at once be used, as there is risk of its conveying infective 

 material into the peritoneal cavity. Besides, its value for diagnosis 

 in such cases is small, owing to the layers of muscle being often dis- 

 placed, and thus occluding the deeper channel of the wound. Where 

 perforation is suspected, the case should be dealt with as if it were 

 proved to exist. Penetration of the peritoneum may shortly be 

 demonstrated by symptoms of peritonitis, marked tension of the 

 abdominal wall, small, wiry, frequent pulse, paleness or dirty red 

 colour of the visible mucous membranes, slight or continuous colic, 

 and, in carnivora, vomiting. Perforation, however, may occur 

 without peritonitis. It may be disclosed by protrusion of abdominal 

 organs, or discharge of the contents of the bowel. 



Every penetrating wound of the abdomen must be regarded as 

 dangerous. The abdominal cavity is now, however, frequently 

 opened, with greatly reduced risk, in surgical operations undertaken 

 for the relief of tympanites, abdominal ascites, and the castration 

 of females and crypt orchids. Numerous accidental injuries with 

 perforation often heal, even in circumstances apparently unfavourable 

 to recovery. (For illustrations showing the relative position of the 

 abdominal contents see Figs. 410, 411, and 412, section on " Puncture 

 of the Bowel.") 



Prognosis principally depends on whether prolapse of the intestine 

 and peritonitis can be prevented. Unlike men, animals cannot be 

 kept for any considerable period lying on the back, or even quietly in 

 the recumbent position, and there is thus greater danger of prolapse 

 of the bowels. Peritonitis may be prevented by antiseptic treat- 

 ment of the wound. So long as asepsis is maintained, recovery 

 need not be despaired of. Even where pus formation has occurred, 

 recovery is not impossible, provided the inflammatory disease has 

 not extended to the peritoneum. Retention of septic fluids and 

 their entrance into the abdomen are the chief dangers, and the 

 prognosis largely depends on the progress of the wound. The 

 peritoneum varies in sensitiveness in the various classes of animals. 

 Wounds penetrating it are less serious in carnivora and ruminants, 

 but more so in horses, in which the risks of peritonitis are greater. 



Treatment. The chief indications are to maintain asepsis and 

 prevent prolapse of internal organs. The first is attained by careful 

 cleansing and disinfection of the wound and its neighbourhood. 

 If necessary, bleeding must be checked by ligaturing injured vessels, 

 and blood prevented accumulating in the wound, but tampons are 

 only employed in case of need. Foreign bodies, and loose shreds 



