ABDOMINAL SURGERY IN AN EVACUATION HOSPITAL

Abstract

A series of 341 patients with abdominal war wounds is presented. This includes 81 patients with combined thoraco-abdominal wounds. Surgery was performed on 312 patients. Many of these patients had additional major injuries. The operative mortality was 20.2 per cent. Eight per cent of the patients died without surgery having been performed. The methods used in making the diagnosis of intra-abdominal injury including the importance of proctoscopic and sigmoidoscopic examinations are discussed. The importance of adequate preoperative treatment as a determining factor in the final result is stressed. The decrease in mortality rate on patients operated upon six to 30 hours after injury is explained in part by the fact that the worst cases are operated upon during the first six-hour period. Delayed operation is not advocated but rather the effort to prepare the patient adequately for operation is stressed. The importance of early surgery in patients with evisceration of abdominal organs is noted. These patients do not respond to the usual forms of shock therapy until surgical replacement of the evisceration is accomplished. Certain surgical procedures that we have employed in the operative management of the various types of injuries encountered are presented. The importance of adequate and well-placed incisions, of systematic and thorough abdominal exploration, and careful abdominal closure is discussed. The necessity for careful closure of the diaphragm and institution of subdiaphragmatic drainage in right-sided thoraco-abdominal wounds in emphasized. The value of intensive postoperative treatment, including the use of penicillin and the sulfa drugs, is shown by the low incidence of postoperative complications. Case histories of selected cases are presented in detail.