. Medical and surgical therapy . e,it is best only to clean them, wash them in hot seiiim,mark the already existing injuries, and cover themwith hot compresses ; the lips of the wound can beattended to afterwards. But we must loait for acomplete examination and verification of the intra-abdominal injuries before suturiyig, resecting, etc., thintestinal loops which have come out of the abdo-men. If we neglect such an examination we riskwasting time on unnecessary local work ; for instance,a loop of the intestine carefully made good may haveto be removed again because there are lesions in itsnei
. Medical and surgical therapy . e,it is best only to clean them, wash them in hot seiiim,mark the already existing injuries, and cover themwith hot compresses ; the lips of the wound can beattended to afterwards. But we must loait for acomplete examination and verification of the intra-abdominal injuries before suturiyig, resecting, etc., thintestinal loops which have come out of the abdo-men. If we neglect such an examination we riskwasting time on unnecessary local work ; for instance,a loop of the intestine carefully made good may haveto be removed again because there are lesions in itsneighbourhood which may affect it. It would bebetter to isolate it carefully with warm saline swabsand then carry out laparotomy at once. 490 WOUNDS OF THE ABDOMEN In certain cases, liernia of the viscera can be treatedat once. The omentum may be exposed by itself ; we canresect, and if the incision for laparotomy does notpass through the actual opening, the stump of omentumcan presently be drawn out of the abdomen itself. -?f 10. Fig. 52.—The various incisions for laparotomy. (1) Transverseincision from orifice to orifice ; (2) sub-umbilical median laparo-tomy ; (3) suprrt-umbilical median laparotomy ; (4) lateral laparo-tomy, outside, the rectus; (o) oblique iliac laparotomy; (6) laterallaparotomy (extreme); (7) horizontal laparotomy; (8) sub-costallaparotomy ; (9 and 10) incisions for a mobile costal flap. (Auvray-Baudet.) We pursue the same course when a parietal openinghas tan^entially abraded the tissues and the peri-toneum, allowing the loops of the intestine to protrudewhether they are injured or not ; if one is sure that PENETRATING WOUNDS 491 there are no other intra-abdominal injuries they canbe repaired at once. Under other circumstances itis better to verify the extent and position of suchinjuries in the prehminary investigation. If there is persistent haemorrhage it may be impor-tant to stop this at once ; in our own case (p. 517 wethus removed the ruptured kidney,
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
