. Medical and surgical therapy . Fig. 26.—^Recoveries by abstention. Sen-cert [2], To compare with the followingfigure. a tunnel-wound caused by a bullet, with very localisedreaction, was treated by lateral laparotomy ; we foundthe rent in the middle of a sanguineous infiltration of 408 WOUNDS OF THE ABDOMEN the meso-colon; at that very moment intestinalcontents escaped. The patient died of peritonitis,which perhaps would not have occurred without inter-vention, as the closure of the laceration seemedestablished. In any case, a mistake of operative procedure hadbeen made; be-fore the lapa-roto
. Medical and surgical therapy . Fig. 26.—^Recoveries by abstention. Sen-cert [2], To compare with the followingfigure. a tunnel-wound caused by a bullet, with very localisedreaction, was treated by lateral laparotomy ; we foundthe rent in the middle of a sanguineous infiltration of 408 WOUNDS OF THE ABDOMEN the meso-colon; at that very moment intestinalcontents escaped. The patient died of peritonitis,which perhaps would not have occurred without inter-vention, as the closure of the laceration seemedestablished. In any case, a mistake of operative procedure hadbeen made; be-fore the lapa-rotomy, as thepassage was solateral, and theintra-perito-neal penetra-tion of the colonwas not cer-tain, I oughtto have ex-plored thecourse of thewound andconfined myselfto a freeopen-ing-up of theextra-perito-neal focus: weare well awareof the difficultyand the uncer-tainty of extra-peritoneal su-tures of thelarge intestine!From thecases that Ihave just col-lected and ana-wounded who,have recovered. P, P?ecal 27.—Recoveries by abstention, ob-tained from a total of 121 cases of Sencert,Cadenat, and Chevassu (retaining only thepenetrating wounds admitted by Tuffier andQu6nu). Of the three wounds in the umbilicalzone, two were accompanied by no reaction,and the third gave rise to a faecal fistula. Thisdiagram should be conapared with the follow-ing figure, lysed it results : (1) That thewithout laparotomy, would certainly TREATMENT TO ADOPT IS LAPAROTOMY 409 recover also in spite of from their abdominal lesionslaparotomy; (2) The wounded who, without laparotomyperhaps have recovered, will almost certainly recoverwith laparotomy; might ^(iSt . (3) Of thewounded who,without laparo-tomy, wouldcertainly havedied, a consider-able proportionrecover in conse-quence of lapa-rotomy ; thatproportion ishere 25%. Toputitsome-what roughly,and in extremeterms : If weare mistaken, wedo not kill anyone; when weoperate on thecondemned, wesave a quarterof them ! Therefore (andbearing
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
