Slight contusions of spleen heal read ily, but rents and tears of any impor tance are frequently followed by fatal hmmorrhage. Abscesses occasionally complicate convalescence.
Case of V-para of 31 in sixth month of pregnancy. Drunken man had trod den on the left side of her abdomen; on following day there were signs of inter nal hmmorrhage. Laparotomy disclosed rupture of spleen as source of bleeding. Spleen extirpated and the woman made excellent recovery and was spontaneously delivered of a healthy child at full term. Tabulated eight reported eases of re moval of spleen for injury, five recoveries. Savor (Centralb. f. Gyn., 1305, 'OS).
The great majority of cases of rupture of the kidney that recover are those in which the initial lesion had been com paratively slight. In the graver cases, in which there is copious hmmorrhage into the perinephric tissues or into the peritoneal cavity, of which the growing exsanguinity of the patient is an indi cation, the prognosis depends upon the speed with which adequate surgical pro cedures are instituted. Occasionally, however, the blood is held in check by the renal capsule.
The prognosis depends greatly, there fore, upon the patient's ability to stand operative procedures suitable to estab lish a positive diagnosis and bring the lesion that may at any moment destroy life within the immediate reach of arts highest powers. When serious injury is rendered probable by the nature of the accident, and the symptoms present also indicate a serious lesion, an explo ratory incision, if the patient is not past relief, a careful examination of the or gans involved, arrest of haemorrhage, closure of the disrupted tissues, or cleans ing of the abdominal cavity may save him even when his condition appears almost hopeless.
Again, the prognosis is influenced by the time elapsing between the accident and the institution of surgical proced ures. The sooner they are resorted to, all things considered, the greater the chances of success.
No case can be considered as hopeless unless a subnormal temperature, cold and cyanosed extremities, and other signs indicate that the end is near.
• A case may be considered as inoperable when there is profound collapse, the tongue being cold, the extremities cya nosed with an imperceptible pulse, and a temperature ranging from 96° to 97° F. Editorial (La lied, Mod., Feb. 15, '96).
A case of penetrating gunshot wound of the abdomen in which, nearly ten weeks afterward, the bullet, weighing 20 grammes, was extracted. The intestines were not opened, the entire fistulous tract being dissected out. He recovered in six weeks. The bullet had a steel casing, and its deformity showed that it had already struck once and had then been deflected. Calcareous particles and bits of clothing were found in the ab dominal fistula. M. Hassler (Jour. de Mod. de Bordeaux, Feb. 3, 1901).
Even when performed late in the his tory of the case, the operative measures sometimes prove successful.
Case in which blow on abdomen caused rupture of pancreas followed by rapid formation of larger pancreatic cyst simu lating closely an abdominal aneurism. Four week's after injury cyst evacu ated through the abdominal incision and drained. Critical condition of pa tient contra-indicated attempt to suture wound in pancreas. On third day fol lowing operation subphrenie abscess was evacuated through a bronchus and pa tient rapidly recovered. There was pro fuse discharge of pancreatic fluid from abdominal wound. The cyst contracted to small sinus, which healed on seventy seventh day after operation. Patient fifteen months after injury was well and showed no functional disturbance of any alimentary process. 14. W. Cushing (Jour. Amer. Med. Assoc., Mar. 7, '93).
The early recognition of a rupture of the bladder greatly influences the prog nosis. About GO per cent. of the most unpromising lesion, intraperitoneal lac eration, arc saved by prompt surgical measures. The remaining 40 per cent.
are unsuccessful mainly on account of delay in resorting to abdominal section. A successful result has, nevertheless, followed laparotomy as much as fifty four hours after the rupture.