Abdominal Wounds

Time was when a stomach wound was almost synonymous with a painful and lingering death. In World War I, only 36% of such cases recovered. But the recovery rate for stomach wounds in World War II is 60%. This startling indication of surgical progress was reported in London by Rear Admiral Gordon Gordon-Taylor in a review for the Royal College of Surgeons of the results of 600 operations performed on Dunkirk veterans, R.A.F. men, bombed civilians.

Most belly-rippers in these cases were fragments of bomb casing, sometimes as large as walnuts. Common abdominal injuries included bowels scorched by incendiary bullets, coils of intestine cut to ribbons by flying glass, or loops of gut hanging out of slashed stomachs. Sometimes, although no missiles penetrated the abdominal cavity, indriven fragments of bone did as much damage as bullets. Concussion of a nearby bomb often produced fatal internal hemorrhages, torn spleen and liver. "Immersion blast"--internal injury inflicted on sailors in the water near an exploding depth bomb--sometimes produced ripped intestines, peritonitis, bleeding from ears and mouth.

Since 20% of all abdominal wounds were caused by missiles which entered through the buttocks, Rear Admiral Gordon-Taylor urged that operating surgeons examine this area very carefully, especially since bullets may leave very minute holes.

It is impossible to tell, from a bullet's point of entrance, what track it may have taken. Often missiles passed clear through the abdomen without damaging any of the viscera. He added that the recovery rate for persons injured by revolver bullets was "flattering" to the operating surgeon.

Small wounds of the intestine, said the Rear Admiral, can be stitched together.

But sometimes, when much damage has been done, it is necessary to cut out the section of damaged gut, patch the whole ends together again. As much as six feet of small intestine, he said, "have been removed with success." Chiefly responsible for the great reduction in mortality are: 1) the liberal use of sulfa drugs, both sprinkled on the wounds and taken internally; 2) massive blood transfusions--in some cases as much as eleven pints--which make possible bolder operations than were risked in World War I.

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