195. Thoraco-Abdominal GSW with Extensive Liver Damage

Elliott, Russell J., Pfc. 35753346 Age 19 C Co 141st Inf.
Injured 1130 hrs. 8 Oct 44 GSW  
1st Bn Aid Station 143rd 1430 hrs. 1 unit plasma sulfa tab 8  
Coll Sta C 111th Med Bn (No time given) 1 unit plasma  
111th Med Bn Clr Sta (No time given) TT 1 cc  
11th Field Hosp 1600 hrs.    

Condition on admission fair. B.P. 90/60. B.S. absent over right side of chest. Abdomen moderately rigid and tender.

Diagnosis: GSW thoraco-abdominal, right, sv.

Pre-op Rx.

1600 hrs.   1 unit plasma
1615 hrs.   1 unit plasma
1630 hrs.   1 unit plasma
1700 hrs. B.P. 120/56 500 cc blood started M.S. gr 1/6
Atropine gr 1/100 IV


1755 hrs. B.P. 150/70 P. 132 500 cc blood & 1000 cc 5% glucose
1820 hrs. B.P. 120/64 P. 140 500 cc blood. Anesthetic begun.
1840 hrs. B.P. 70/30 P. 120 Surgery begun. Pt. on left side.
50,000 units Penicillin in chest.
1855 hrs. B.P. 90/40 P. 140 Turned on back. 500 cc blood.
1915 hrs. B.P. 84/40 P. 124 500 cc blood. Anesth discontinued
25,000 units Penicillin IV
1940 hrs. B.P. 120/40 P. 118. Surgery completed.

Both chest wounds sucked during induction of anesthesia. Wd of exit debrided. Large chest wall defect. Fractured 11th rib trimmed. Considerable free blood and blood clots in rt pleural cavity. Rt lower lobe site of hematoma (extensive). No evidence of broncho-pleural fistula. Two large wds of diaphragm through which pieces of liver were herniating. Diaphragm closed with interrupted silk sutures. Intercostal catheter inserted. Chest wds closed with chromic catgut in layers. Expl lap thru high right rectus incision. Considerable free blood and some fragmented pieces of liver loose in peritoneal cavity. Extensive perforating wd of right lobe of liver with much fragmentation of this lobe of liver. Colon neg. Small bowel neg. Two penrose cigarette drains led to fracture site (liver) thru sub-costal stab wd. Wd of abdomen closed in layers. Retention sutures through all layers. Penrose drain down to post. sheath of rectus. 50,000 units Penicillin injected into rt pleural cavity. Condition at end of op good. B.P. 120/40. P. 118. 2,000 cc blood.

10-10-44 Respirations have been rapid and shallow. Both lung fields moist. Required inter-tracheal aspirations last evening. Intercostal tube stopped draining—was removed this a.m. Thoracentecis removed few cc of stringy clots. Using Ephedrine SO4 gr 3/8 and Atropine SO4 gr 1/100.
10-12-44 Soldier developed pneumonia in left lung—broncho. Sulfadiazene started night of 10-10. Condition now much improved. T 100 P. 102 R 26.
10-20-44 Subdiaphragmatic abscess subsiding? T 99 to 101. Aspirated 300 cc serosanguineous fluid from rt chest today and 700 cc on 10-18-44.
Dec 22 Received letter today from Elliott from Italy. Is well and up and around. Had tube drainage at Base Hospital.

Italy Dec. 5

Dear Sir,

Thanks to you I am almost well again. I have had another operation since I have been hear, they put a tube in my side. The tube is only about two inches long now and it is about time for it to be cut off again. I have been out of bed about two wk. I am gaining back some of the waight I lost. Thanks for every thing you did for me.

Yours Truly,
Russell Elliott.

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