254 
PENETRATING WOUNDS OF THE ABDOMEN. 
the 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, 
the distension of the abdominal wall, small, wiry, frequent pulse, pale¬ 
ness 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 dan¬ 
gerous. The abdominal cavity is now, however, frequently opened, with 
greatly reduced risk, in surgical operations undertaken for the relief of 
enteric tympanites, abdominal ascites, and the castration of females and 
cryptorchids. Numerous accidental injuries with perforation often heal, 
even in circumstances apparently unfavourable to recovery. (For illustra¬ 
tions showing the relative position of the abdominal contents see figs. 148, 
144 and 145, 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 their back, or even quietly in the recumbent 
position, and there is thus greater danger of prolapse of the bowels. 
Peritonitis can be prevented by antiseptic treatment of the wound. So 
long as asepsis is maintained, recovery need not be despaired of. Even 
where pus formation has occurred, this 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 whether they can be prevented or 
not. 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 of tissue, likely to 
become necrotic, should be removed. The wound is washed out very 
carefully with disinfectants, one of the best of which is, corrosive sub¬ 
limate. It may then be sutured with sterilised silk ; cat-gut is not 
sufficiently strong. The abdominal muscles and the skin should be 
brought together separately with deep stitches, so that should washing- 
out afterwards become necessary the outer stitches need alone be 
loosened. On account of the great strain which the stitches must 
