Abdominal injuries: With special reference to errors in early handling

Abstract

We believe that present world conditions emphasize the importance of the care of the injured. As regards abdominal injuries, we have presented a list of principles and observations, known well to those of this organization, but worth formulating and recording again. 1. 1. Treat shock patients properly. Blood is the principal agent, and sufficient amounts should be available. 2. 2. Remember the possibility of autotransfusion. 3. 3. Bronchial suction will save lives and reduce pulmonary complications. 4. 4. Two-thirds of abdominal injuries with no external signs are serious. 5. 5. Perforations may be caused by the proctoscope, gastroscope, curette and by cancer. 6. 6. Gastric and rectal tubes are diagnostic and reduce drainage into the peritoneal cavity; however, do not irrigate the stomach or rectum when the patient is first seen. 7. 7. A portable x-ray unit is essential. 8. 8. Be alert for free air in the peritoneal cavity. 9. 9. ACTH, blood and antibiotics often mask serious symptoms. 10. 10. Regardless of the ability of the surgeon and optimum operating conditions, a minimum of two hours is consumed in exploratory laparotomy and the subsequent repair procedure. 11. 11. A foreign body should be removed, if practical, at the time of laparotomy, but the operation is primarily to repair the damage created by the object. 12. 12. Test bowel patency with the thumb and index finger after anastomosis. 13. 13. Do not use antibiotics in the abdomen. 14. 14. Colostomies will retract; therefore, leave them long and have them emerge through stab wounds. 15. 15. Remember disruption when closing abdominal wounds. 16. 16. Postoperatively, give nothing by mouth until the patient passes gas from below. (This may occur one to five days postoperatively.) 17. 17. Anticoagulants are impractical in the early care of abdominal injuries. 18. 18. We want to emphasize what has been the experience of the Committee on Trauma of the American College of Surgeons, namely, that in order to administer adequate emergency care to the injured it is essential to make frequent checks on our emergency wards, have frequent meetings of interested members of our hospital staffs and to issue periodic bulletins outlining standard procedures and calling attention to advances in new methods and therapeutic agents.