Surgery of Modern Warfare VI. (töredék) [antikvár]

CHAPTER LXXVI WOUNDS OF THE LARGE INTESTINE A LTHOUGH anatomical disposition often preserves the large gut /% from those multiple wounds which characterize injuries of the small / m intpstinp! produced by missiles, it must be remembered that on the left side of the peritoneal cavity the descending and ihac portions of the colon are frequently overlapped by coils of small gut. Penetrating wounds of the colon, especially on the left side, are therefore often accompanied by wounds of the small intestine ; indeed, in only about 60 per cent, of the cases is the colon alone involved. Wounds of the sessile segments of the colon are not infrequently associated with injuries of the kidney ; lacerations of the flexures may be comphcated by wounds of the liver, stomach or spleen, and the possibility of an abdomino-thoracic lesion (see p. 847) should not be forgotten. Fractures of the bony confines of the abdominal and pelvic cavities add to the gravity of lacerations of the large gut. Concomitant fractures of the bones of the lower hmb, especially the femur, frequently turn the scales against the patient's survival. When the colon is the one viscus involved, the mortality is higher than when the small gut alone is the abdominal organ damaged. My own Bradshaw Lecture (1942) dealing with a collected series of abdominal injuries showed a recovery rate of 40 per cent, of all cases of injury to the colon submitted to operation,^ against a recovery rate of 47-3 per cent, of cases of wounds of the small intestine confirmed by laparotomy. The graver nature of the large intestine wound is more clearly demonstrated by contrasting the recovery rate of cases where the lesion was confined to the colon—45 per cent.—^with the 64 per cent, recovery rate where laparotomy showed that the small gut alone was damaged. However, more recent figures relating to colon wounds from the Mediterranean sphere of military operations are more encouraging than those just quoted. Possibly several causal factors have contributed to the increased recovery rate, but exteriorization of the colon and frequent colostomy of the damaged intestinal segment must be regarded as modifications of technique which have appreciably lowered mortality. Gibhn, from his own personal experience, was able to write that wounds of the colon, if exteriorized, are no more fatal than those involving the small bowel, and that a recovery rate of at least 70 per cent, is to be expected, if patients come to operation within twelve hours. Personal communications from other surgeons on the southern shores of the Mediterranean attest the improved results from colon exteriorization. Uo information, liowever, is forthcoming as to tl:e rercentage of tl;c total number of colon iniuries for -wlucli operation was, m fact, performed. 104 897