194. Fatal Thoraco-Abdominal Shrapnel Wound

Carroll, Troy D, Pvt. 38641081 Age 19 G Co 141 Inf
Injured 0630 hrs. 10-5-44 S.F. multiple  
2nd Bn Aid Sta 0800 hrs. 2 units blood plasma Sulfa D  
Coll. Sta A. 0905 hrs. 1 unit plasma    
Clr. Sta 111th 0950 hrs. 1 cc T.T.    
11th Field Hosp. 1000 hrs.      

Gen’l condition on admission poor--severe shock (in extremis) B.P. 80/40 P 120. Respirations difficult. Thoracocentesis right 1200 cc blood--2000 cc air. Needle with water trap connection inserted in 3rd I.S. right for tension pneumo.

Coramine amp III at 1015 hrs. Intratracheal catheter inserted and 100 cc blood aspirated from trachea.

I.V. & times

1015 1 unit plasma. 1030 hrs. 500 cc blood in each arm. 1100 hrs. 500 cc blood in each arm. 1100 hrs. B.P. 100/40 1110 hrs. O2 by nasal catheter 1200 hrs. 25,000 units penicillin I.V. 1300 hrs. B.P. 100/60 1300 hrs. 500 cc blood Thoracocentesis right pleural cavity 100 cc blood & air.

Diagnosis: S.F. wds. multiple pen thorax right sv; abdomen, rt. sv; buttocks rt. sv.; ankle, rt sv. F.B. (small) in ankle joint.

1315 hrs. B.P. 118/54 P. 128 R. 24 (500 cc blood started in shock)
1330 hrs. B.P. 110/50 P. 112 Anesth--Endotracheal E & O2
1355 hrs. B.P. 78/40 P. 84 Surgery began.
1420 hrs. B.P. 60/25 P. 100  
1430 hrs. B.P. 0/0   Anesth discontinued
O2 only 1000 cc blood
1445 hrs. B.P. 40/20 P. 100  
1500 hrs. B.P. 50/30 P. 100  
1520 hrs. B.P. 54/34 P. 100 500 cc blood
1530 hrs. B.P. 64/40 P. 100 R. 24
1545 hrs. B.P. 70/40   Surgery ended
500 cc blood.

Wds of right chest debrided (sucked at time of op) & closed with chromic catgut. Size 14 F catheter inserted in 3rd interspace ant.--led to water trap. Wd. at level of right anterior axillary line at costal margin debrided and closed out to skin. Adb. opened through upper rt. rectus incision. Abd. filled with blood which continued to well up from subhepatic space. There was a large perf. wd. of right lobe of liver and the inf. vena cava was lacerated for 1 inch just to the left of the common bile duct and posterior to foramen of Winslow. The bleeding was controlled with two long curved clamps which were brought out the lower end of the incision. Suture was impossible. F.B. not removed. Three penrose drains brought out a right subcostal stab wd. Drains placed into Morison’s pouch. One drain placed subdiaphragmatically. Large wds of rt. buttock debrided and dry dressings applied. Left ankle joint debrided and dry dressing applied. 4500 cc blood pre & during op.

10-10-44 Pt died 0009 hrs. Post op course was unhappy. Rt. lung never expanded; left lung was constantly moist in spite of tracheal aspirations. Post revealed abdomen to be clean. Clamps had been on Inf vena cava. It was patent and in good condition. Rt lung was one large hematoma with a hole 3 cms in diameter leading thru it from front to back--it connected with a large primary bronchus. Left lung moist but grossly negative.

Back to All Surgical Cases