Manual of surgery / by Alexis Thomson and Alexander Miles.

  • Thomson, Alexis, 1863-1924
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: Manual of surgery / by Alexis Thomson and Alexander Miles. Source: Wellcome Collection.

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    as when an individual is seated, and a heavy weight falls on his shoulders, compressing the contents of the abdomen. Those which result from falls from a height are chiefly of medico-legal interest. | Certain parts of the intestine are more exposed to injury than others, some in virtue of their situation, for example, the centrally placed coils of small intestine, others from their attach- ments, for example, the duodeno-jejunal junction. Distension of a hollow organ such as the bladder or stomach renders it more liable to rupture. Certain diseases also, for example, ulceration of the stomach or malarial enlargement of the spleen, predispose to rupture. The viscus may be merely contused or it may be ruptured. Rupture of the liver, spleen, mesentery or omentum is dangerous chiefly because of the resulting hemorrhage and possible death from loss of blood. Injuries in the epigastric region may lead to hemorrhage in or around the pancreas and accumulation of blood-stained fluid in the lesser sac of the peritoneum. In the case of hollow organs such as the stomach, intestine or urinary bladder, the chief danger is from the escape of their contents into the peritoneal cavity setting up septic peritonitis. In hollow organs a distinction may be made between complete and incomplete rupture, in the former all the coats are torn through, and the contents escape at once unless the opening is blocked by omentum or protruded mucous membrane. In the case of incomplete ruptures one or other of the coats remains intact, and the escape of contents is thereby prevented. The rupture may, however, become complete as a result of infection and subsequent necrosis. Clinical Features of Visceral Lnjuries.—These necessarily vary with the nature and severity of the violence, the extent of the Injuries, and the viscus injured. Ag a rule there is no evidence of bruising of the abdominal wall. The degree of shock is especially liable to variation ; it may be slight and evanescent, or it may be so great that death ensues within a few minutes. Vomiting when present usually continues after the stomach has emptied itself of food. There is persistent pain which radiates over the whole belly, and is increased by the least movement or manipulation. The abdominal muscles become contracted, immobilising the abdominal wall, and as the action of the diaphragm is restrained the respiration becomes almost entirely thoracic. The rigidity and flattening of the belly may give place to fulness and prominence, either as the result of the gaseous distension of the paralysed bowel, or from the escape of