Chips from a surgeon's workshop : five consecutive cases of gunshot wounds of the abdominal viscera treated by abdominal section : two deaths, three recoveries / by A.C. Bernays.

  • Bernays, Augustus Charles, 1854-1907.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Chips from a surgeon's workshop : five consecutive cases of gunshot wounds of the abdominal viscera treated by abdominal section : two deaths, three recoveries / by A.C. Bernays. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    cava and their branches but also the thoracic duct, the sym- pathetic ganglia and nerve fibres would be more or less inter- fered with. The correctness of this view was afterwards proven by the autopsy. The cavity was cleansed with warm water, and all clots and some liquid which had escaped from the stomach were carefully removed. The abdomen was closed in the usual manner. Considerable difficulty being ex- perienced in replacing the eventrated intestines, as it was im- possible to secure complete relaxation of the abdominal mus- cle by extreme chloroform narcosis. Duration of operation one hour. Patient did remarkably well for twenty-four hours and then rapidly growing worse died at 7: 30 p. m. on Dec. 17th. His temperature reached 100° and his pulse which was 78 twenty-four hours after the operation ran up to 140, during the last six hours of his life. He died in collapse which was due to subperitoneal lesions and to an acute and most likely septic peritonitis. I have noticed -that in strong patients peritonitis will often make no impression upon the pulse and but little on the temperature for a period of thirty-six to forty- eight hours. At the autopsy (Coroners’ post-mortem) besides the facts just related, a perforation of the duodenum at its lower con- nection with the head of the pancreas was found, which had been overlooked at the operation. The wounds of the stom- ach that had been stitched were nicely and firmly closed. After passing between the duodenum and the head of the pan- creas the ball glanced off from the body of the second lum- bar vertebra lacerating the right renal vein and some small lumbar arterial, branches. The right kidney as well as the vena cava and all the other vessels and nerves along the ver- tebral column were completely surrounded by extravasated coagulated blood. The bullet passed backwards into the lum- bar muscles. There was general peritonitis, some contents had escaped from the perforation in the duodenum. Had I known of the existence of the laceration of the renal vein I might have lig- ated the renal artery or perhaps have enucleated the entire organ. Which of the two procedures would have been most likely to be successful, can only be decided by experiments. So far as I am aware the renal artery has never been ligated