. Medical and surgical therapy . hegreater curvature large enough for the fist to enter ;the great omentum was detached for 15 cm. In such cases the lesion is in itself difficult to treat,and it is rendered still more so if it is accompanied by agreat outpouring of septic fluid into the peritoneum. The transverse colon is open to the same commentsas the small intestine. And, in estimating the pxoba-biHty of spontaneous heahng, one could not counton the fortunate accident of a free spontaneous com-munication with the exterior. :m WOUNDS OF THE ABDOMEN In tlie ascending and descending colon, the
. Medical and surgical therapy . hegreater curvature large enough for the fist to enter ;the great omentum was detached for 15 cm. In such cases the lesion is in itself difficult to treat,and it is rendered still more so if it is accompanied by agreat outpouring of septic fluid into the peritoneum. The transverse colon is open to the same commentsas the small intestine. And, in estimating the pxoba-biHty of spontaneous heahng, one could not counton the fortunate accident of a free spontaneous com-munication with the exterior. :m WOUNDS OF THE ABDOMEN In tlie ascending and descending colon, the benignityof wounds is not so probable in the case of shell-fragments as with rifle-bullets or shrapnel. In mostcases the damage is extensive, the lacerations wide, andthe hifimorrhage abundant. The wound extends to theintraperitoneal region by an irregular aperture, so thatsome of the intestinal contents may fall into the ab-dominal cavity ; they are then infinitely more septicthan when coming from the small intestine, and thus. Fig. 11.—Typical explosion of the liver by bvillet. It was athoraco-abdominal wovmd, with multiple lesions of the lung, liver,and right kidney. Abstention; death. Cotte and Latarjet [**],Obs. II. the comparative benignity of the wounds of the colonand those of the small intestine is reversed. Extensivewounds of the colon, except in the case of a simplewound making an artificial anus permitting completeevacuation outside, are of the greatest gravity. In the region of the liver, fissures or grooves thatenter the parenchyma somewhat deeply give rise to ANATOMICAL LESIONS sar) hsemorrhages and discharge of bile which are not proneto spontaneous healing (Fig. 11 and Plate I, p. 4-i)Z).Similarly, very small projectiles (spHnters of grenades)excavate, by their gyratory movement, veritablecaverns in thfe hepatic tissue. Le Fort has reported a typical case of this : hitin the paravesicular region, a patient developed alimited hepatic necrosis, and ehminated a
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
