ABDOMEN, Gunshot Wounds of.
Whilst the treatment of gunshot wounds of the abdomen is essentially surgical, the success or otherwise of operative measures often depends more on the early management of the case than on the operation. In considering the treatment of such wounds we find the main causes of death to be (r) Shock, (2) Haemorrhage, and (3) Infection. Let us take each of these in turn.
(t) Shock.—This can best be combated by (a) the application of warmth in the form of hot blankets, hot bottles, etc., around the patient. In the treatment of shock, according to Cuthbert Wallace, " the applica tion of warmth greatly transcends the administration of stimulants. (b) The relief of pain by the hypodermic injection of gr. of morphia combined with i u u gr. of atropine. It is better to repeat a small dose than to give one large one. This allays anxiety as well as pain and pro motes sleep. (c) The relief of thirst by the introduction of fluids by the mouth, by the rectum (if uninjured), subcutaneously or intravenously. (d) The relaxation of the abdominal muscles by putting the patient in the semi-sitting posture—a posture which must be maintained if the patient is to be moved for operation. Under this treatment a patient's general condition will usually improve, and often cases hitherto hopeless recover sufficiently to allow of operation.
(2) Hcemorrhage may arise either from large vessels or from solid organs. In the former case the vessels must be tied at open operation; in the latter, though bleeding will usually stop of its own accord, a con dition which may be recognised by a slowing of the pulse and an increase in its volume, an operation will also be necessary for the clearing out of clot to prevent sepsis or adhesions.
(3) Infection is due either to external contamination or extravasation of bowel contents. In the former case bowel will usually have been prolapsed; this should at once he protected by a large towel rung out of hot normal saline solution, unless surgical assistance is not forthcoming, when a complete toilet of the abdomen and thorough douching of the gut should take place before it is reduced. In any case, if the patient's general condition admits of it a laparotomy should be performed as soon as possible for the purpose of dealing with bleeding, closing perforations of gut by purse-string suture, and providing for free drainage of material already extravasated.—S. T. I.