War Surgery and Medicine
Blood in the Abdomen: In the series of 102 patients who died following operation, 33 had a large quantity of blood in the abdomen and 18 had a moderate quantity. The amount in all cases was sufficient for special mention to be made of it in the notes. The total percentage was 50, so that half the deaths were associated with at least a moderate amount of blood in the abdomen. The records of these cases demonstrated clearly that the prognosis is bad when there is much blood in the abdomen. (This is associated with severe injuries to kidney, liver, and, less commonly, spleen, as well as with damage to the large vessels and especially to the mesenteric arteries.)
Of the 123 patients who survived, only 7 had a record of excessive blood and 16 of moderate bleeding.
Faeces: The presence of faeces was noted in 10 cases, and all the patients died.
Bile: The presence of bile was noted in 4 cases, and all the patients died. The bile was associated with severe damage to liver or ducts.page 270
The mortality in these cases was noted by most observers to be high, but with the utilisation of the thoracic approach there followed a great improvement.
Major Stead reported an overall mortality of 68 per cent. Of 19 cases with sucking wounds 17 had laparotomy and only 2 survived, a mortality of 79 per cent. Of seven cases treated solely by thora-cotomy the mortality was only 35 per cent. Major Blackburn reported a mortality of 36·5 per cent in a series at the end of the war.
In the New Zealand series in Italy (which included a further 44 cases not recorded in the main abdominal survey, and in which there were 21 deaths and 23 recoveries) the mortality was 49·4 per cent. This covers all cases admitted alive or dead to a medical unit, including the Field Ambulances. Of the total of 73 cases, 54 were operated on, and of these 31 (57·4 per cent) recovered.
|Operations||Number of Cases||Recoveries||Per Cent|
|Thoracotomy and laparotomy||9||3||33|
Of the 13 cases which died from thoraco-abdominal injuries without operation, 11 died in the first twenty-four hours, and about half these were brought in dead to the Field Ambulances. The 73 thoraco-abdominal injuries represented 20 per cent of the total of 364 abdominal casualties.
The heavy mortality in the thoraco-abdominal cases is partly explained by the severity of the injuries, which were recorded as follows: severe abdominal injuries (unspecified), 4; severe liver injuries, 10; lesser liver injuries, 9 (6 lived); kidney injury with nephrectomy, 2; splenectomy, 11 (7 lived); suture of spleen, 1 (lived); small intestine injury, 4 (all lived); colon injury, 7 (5 lived); stomach injury, 3 (2 lived); gall bladder, 1 (lived).
Other associated injuries recorded were: fracture of femur, 2; brain injury with hemiplegia, 1; severe retro-peritoneal bleeding, 2; severe mutilating face injury causing death, 1.