Non-penetrating Wounds.
Non-penetrating wounds are usually due to pointed cutting or blunt instru ments.
The lesions caused by a pointed in strument, involving the skin and muscles only, are usually very slight. With due aseptic precautions careful exploration of the wound with the finger may be re sorted to if the visceral examination do not suffice. Probes had better not be used, lest the wound be transformed into a penetrating one.
Lesions caused by cutting instruments (knives, swords, etc.) vary in importance according to their depth and length. When the muscles are cut, the support for the abdominal organs is compro mised, and ventral hernia may follow, unless great care he taken when the wound is closed.
Lesions caused by blunt bodies (such as shot, glancing bullets, and fragments of shells, etc.) are usually attended by symptoms of contusions corresponding in intensity with the force of the blow. Severe laceration of the abdominal tis sues may thus be caused and death occur from intestinal lesions.
The haemorrhage attending these vari ous kinds of wounds is usually slight. There is considerable ecchymosis, but this soon disappears. Occasionally shots or bullets become imbedded in the ab dominal tissues.
Treatment.—After carefully arresting bleeding, cleansing, and disinfecting the wound, the tissues are united. In deep incised wounds the prevention of ventral hernia should be borne in mind, and the cut muscular tissues brought accurately together by means of catgut sutures. This being done, silk sutures are also introduced and brought out to the sur face, thus including the muscles and skin. Capillary drains are alone to be used, if drainage is at all necessary, larger drains affording opportunity for the formation of a ventral hernia. The abdomen should be supported by means of a bandage applied over the dressing and the patient kept in bed until com plete repair of the wound has taken place; from two to five weeks, as a rule. The bandage should be carried long after recovery. and the patient be warned of the danger he might incur by violent movement or strain.
Penetrating Wounds.
The softness of the tissues of the abdominal parietes causes them to be easily penetrated, and the organs within the cavity are all vulnerable for the same reason. The interstices between them occasionally allow the harmless passage of a weapon or bullet, but such cases are extremely rare, only nine such cases having been recorded during the Re bellion.
The missile may graze the peritoneum and barely miss it along with the deeper organs. Unfortunately wounds causing laceration of one or more of the abdom inal viscera are the most frequent, and their fatality is proverbial unless a timely diagnosis allow of prompt protective measures.
As is the case in contusions, the di rection from which the missile or stab comes is of great importance. A bullet arriving from the side and striking near the linea alba would probably create a button-hole wound or bury itself in the abdominal walls. A bullet coming from the front, on the contrary, would most probably perforate the organs in its axial line of flight. If the bullet has passed through the body an imaginary line between the entrance and exit will probably indicate the organs injured, including, of course, the peritoneum. Here again, however, the spinal column may cause deviation when the initial velocity of the bullet is small, and a deceptive line of injury furnished. To positively determine the course of a bullet is difficult in many cases.
In stab wounds the opening is fre quently of a sufficient size to permit pro lapse of the omentum: an evident proof that the abdominal cavity has been penetrated. This rarely occurs in bullet wounds unless a large projectile, or a bullet coming from either side of victim, have caused comparatively large solution of continuity of the tissues. Prolapse of the omentum is most frequently ob served in lesions of the left side. Coils of the small intestines are also frequently prolapsed and, in rare cases, the stomach, the liver, or the spleen have appeared between the lips of the wound.