ABDOMINAL WAR WOUNDS.
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ABSTRACT: Background: Medina Hospital, a Police Hospital in Mogadishu South, Somalia was closed after the civil war broke out in 1991. With the support of the International Committee of the Red Cross (ICRC), was reopened as community based hospital in 2000. The authors present their experience in the treatment of penetrating abdominal war wounds involving the colon in Medina Hospital. Methods: A retrospective descriptive study of civilian and military casualties with penetrating abdominal war injuries involving the colon, treated in Medina Hospital from June 2000 to June 2002 was undertaken. Results: A total of 3496 war wounded patients were treated in Medina Hospital during the period under review. Among them 950 presented with penetrating abdominal war wounds, with large bowel involvement in 430 of them. Initially, 237 (55%) cases of large bowel injury were treated with colostomy; 193 had primary colon closure without any significant increase in the complication rate. Conclusion: In war situations colostomy may be avoided by performing primary repair of the penetrating large bowel gunshot wounds.East and Central African Journal of Surgery (ISSN: 1024-297X) Vol 8 Num 1.
CALIFORNIA STATE JOURNAL OF MEDICINE Vol. XVII, No. ii
mouth of the Congo, watching for slavers.
wards, for years, he enjoyed a large general prac-
tice in Oakland.When past the acme of
he was appointed Professor of Gynecology in the
of Medicine, and
ropean clinics, especially those of England.
time when, because of the new antiseptic methods,
the older men in surgery were going down like
ninepins in a bowling alley, he swept forward to
becoming the chief abdominal surgeon on the Pa-
Besides his age, he had yet another
much dependent upon commerce for its eminence.
As a rule the large commercial centers are also
the medical centers.
San Francisco in I886 was
declining; Portland, Seattle and Spokane on the
North, and Los Angeles in the South were cut-
In spite of this Cuishing's
sphere of influence
for many years grew wider
Chismore was another example of a man chang-
ing his work late in life.
sailor, then a miner, then .a dentist, and then a
contract army surgeon.
he took his degree in the Lane Medical College
Hospital for Women, and then bent his energies
a great and deserved
honest, more straightforward nature never existed.
of his early
delight of every company he was in, and were the
Robert Louis Stevenson.
cieties, and the Obstetrical Society of San Fran-
cisco was no exception.
terest or dropped out. or other societies and com-
binations engaged their attention.
savs that the finishing touch was the Last Supper
given in my home;
any rate the society passed into history a good
not, however, without having
furnished much in instruction and much pleasure
to its members.
323 Geary Street.
and was on
As a boy he was a
After leaving the army
in the California
in which he achieved
in Alaska were the
its terminus, even medical so-
The men either lost in-
it may be heis right.
ABDOMINAL WAR WOUNDS.*
By REA SMITH, M. D., Los Angeles.
Penetrating wounds of the abdomen causing vis-
ceral injury were as a rule fatal on account of the
lack of transport, and delays in getting the patient
to the operating table.
At Evacution Hospital No.
II4, we received patients from 6 to 72 hours after
Many of the
wounds were moribund either from hemorrhage or
from peritonitis already well developed.
If any one change could be suggested to better
conditions in war for men with abdominal wounds,
*Read before the Forty-eighth Annual Meeting of the
cases with abdominal
it would be a special line of transportation, with
rapid passage through forward stations and treil-
Machine gun bullet wounds were usually from
the front, and the patients were not unlike the
patients that we are all accustomed to see in the
accident surgery of civil life.
to take up your time with wounds of the solid
here with due regard to hemorrhage shock.
Intestinal perforations were as a rule multiple.
Our policy was to do as little surgery as possible;
rapidly sewing up the perforations and resecting
only when absolutely necessary on account of dam-
aged circulation or extensive injury to the intestinal
wall.It was necessary, however, to search care-
fully for all wounds in the intestines, and not be
satisfied by finding and closing one or two.
Wounds made by shell fragments were usually
in the back, as soldiers dropped on their faces when
they- heard a shell in the air or when their position
was being shelled.
The gr'eatest surprise' was at
the frequency with which the shrapnel was arrested
and turned in its course by the parietal peritoneum.
It was the rule rather than the exception to find
that shrapnel had gone to the peritoneum and been
deflected by it, rather than that it'had gone straight
had gone through the ileum, carrying a block of
bone its own size and shape with it, and had then
been deflected down into the pelvis without wound-
ing either the peritoneum or bladder.
These wounds were accompanied by
peritoneal hematoma, usually dissecting and exten-
sive, and I think on that account largely the differ-
ential diagnosis between penetrating or non-pene-
trating wound was made most difficult.
The peritoneal irritation incident upon its being
loosened, from its attachment and stretched by accu-
mulated blood, gave all the signs of peritoneal irri-
tation due to infection. We had rigid muscles of
the anterior wall with great tenderness, and the
peritoneal snap in the pulse.
Add to that the localization of the foreign body
by the X-ray at a point that
abdominal, but that has become extra peritoneal
by the encroachment of the hematoma on the peri-
toneal cavity, and dullness in the flank due to the
confined blood, and a picture is presented that will
*force almost any abdominal surgeon to open
Many of these patients were opened and
clean peritoneal cavity found.
of laparotomy did not help the patient's chances of
excise the wound of entrance, remove the foreign
wound, and make the patient safe for transporta-
tion, and more careful study at the base.
I did not think
symptoms of visceral' abdominal injury simulated
so closely by any extra'peritoneal lesion, as I saw
over and over' again.
And I have presented' this
small paper to you. to make that one point that
may or 'may not be of value to you at some time
in the surgery of civil life.
It is not my purpose
it was necessary to treat there as
I saw several cases in which the missile
is palpably intra-
The added shock
it was a simple procedure to
it possible to have signs and