258. “A one case day, but what a case that was:” Nephrectomy and Cholecystectomy

White, Cliffton B., Pvt. 38677535 Age 26 K CO 411 Inf. Regt.
Injured 0915 hrs. 21 Dec. 44 H.E.S.F.
3rd Bn Aid Sta 180 Inf. 1030 hrs.   M.S. gr ½ in field
Coll Sta Co C 120th Med Bn 1215 hrs.    
Clr. Sta. 120th Med Bn 1330 hrs.    
57th Field Hospital 1340 hrs.    

Gen’l condition on admission poor. B.P. 50/38 P. 108. Pale suggesting blood loss. Wd dressing soaked with blood. Abdomen rigid and tender ++++.

Diagnosis: S.F.W. pen lumbar region right involving kidney, duodenum, mesocolon, gall bladder, liver.

Preop Rx

1345 hrs. B.P. 50/30 P. 108 Plasma started.
1440 hrs. B.P. 138/80   Catheterized--urine grossly bloody. Levin’s tube passed. 1000 cc plasma & 500 cc type O blood.


1610 hrs. B.P. 130/70 P. 120 Endotracheal E & O2. 1000 cc N.S. & G
1620 hrs. B.P. 110/60 P. 124  
1640 hrs. B.P. 70/40   Pt. turned on side.
1645 hrs. B.P. --- Operation began. Plasma 250 cc.
1700 hrs. B.P. 64/40 P. 120  
1710 hrs. B.P. 90/50 P. 112 Plasma 250 cc. Blood "A" 500 cc
1730 hrs. B.P. 90/50 P. 108  
1805 hrs. B.P. 90/50 P. 112 Turned on back. Blood 800 cc "A"
1820 hrs. B.P. 70/40 P. 116 Abd. opened.
1830 hrs. B.P. 100/58 P. 112  
1900 hrs. B.P. 100/60 P. 104  
1930 hrs. B.P. 104/70 P. 88 250 cc plasma.
2005 hrs. B.P. 150/60 P. 100 Op. ended.

Pt. on left side. Pen. wd. debrided. Digital examination revealed a severe fracture laceration of right kidney at its mid portion. Considerable bleeding from this wound. Flank incision made and kidney exposed--intra capsular dissection--Kidney delivered. There was seen to be an extensive fracture laceration of the kidney involving the pelvis. Nephrectomy was demanded. Kidney removed. There was a leakage of small bowel contents into kidney bed from a point ant. to the kidney pedicle. Found to be coming from the 2nd portion of the duodenum. This was further explored and exposed. Perforation was 3 cms. in diameter. Closed with chromic catgut and interrupted silk. Penrose cigarette drain and one penrose drain plain led to this site. Kidney incision closed in layers. Drains delivered thru posterior angle of wd. Pt. turned on back. Laporotomy thru high right rectus incision. Bile and blood poured from peritoneal cavity as it was opened. Small bowel examined--found negative. Gall bladder severely lacerated along almost its entire length over its anterior surface. Cholecystectomy--was easiest and quickest procedure; Cholecystectomy done. Hepatic flexure turned medially and duodenum further explored. The exit wd. of the 2nd portion of duodenum was found; it was approximately 3 cms. in diameter. Immediate mucosal surface examined for ampulla of Vater. It was not seen. Perforation closed with catgut and interrupted silk sutures. Tract of missile was thru kidney, duodenum, mesocolon of right transverse colon, gall bladder, between right and left lobes of liver lacerating each, passing thru falciform ligament, lodging in superior surface of left lobe of liver. Transverse colon not perforated but there was such a perforation in the mesocolon of the right half that the blood supply was jeopardized. This loop was therefore exteriorized for safety sake thru left subcostal stab wd. G.B. wd. and liver lacerations drained thru right subcostal stab wd. Four retention sutures thru all layers. Abd. closed in layers. 800 cc type A Blood. 500 cc plasma. 1000 cc 5% glucose in saline.

Dec. 22 Condition satisfactory. B.P. 120/80 since operation. Bile in Wangensteen drainage. Sulfadiazine 5 gms. IV daily started.
Dec. 23 500 cc. Had reaction to glucose.
Dec. 26 500 cc blood. Hematocrit 32.0. Passing gas per rectum.
De. 27 Drains shortened. Wds. look clean. Little drainage from posterior wd. T.P.R. only slightly elevated.
Dec. 29 Soft low residue diet. No retention.
Dec. 30 Considerable drainage from kidney incision: thick, gelatinous, no odor.
Dec. 31 Flank irrigated with saline. There has been considerable break down of this wd. except for skin. Penrose drain reinserted. T. to 101. Belly soft.
Jan. 1 Copious drainage. Bile stained. Thick. No odor. Wd. irrigated with saline & Azo chleramide in oil instilled. Drain reinserted. T. normal. Chest neg.
  Evacuated because of the tactical situation.
Feb. 7, 1945 Was operated at 46 Gen'l. Loop returned to abdomen. When pt. wrote wd. was healed and pt. was up and around.

Pvt. Winston B. White 38677535
Det of Patients
Hospital Plant 4405
APO 667
U.S. Army

Jan 30, 1945

Dear Dr. Kennedy:

I thought I would drop you a few lines to let you know how I am getting along. When I left your care I went to the Evac. Hospital, there I stayed overnite and was shipped to the 46th General Hospital the next day. I did fine for the first eight days, even sat up in a wheel chair. I taken sick one nite with gas pains. I had them for two or three days, they were really bad. The Dr. here, by the way is really Alright, his name is Cpt. Diack, decided that the loop on the ant. side had swollen and kept the gas from passing through. They took X-rays & they may found out something else that I didn’t know about. They operated on me again & droped the loop & also found out that my intestants had two kinks in them. They straighten that out and sewed me back up. Right now I am up and walking around & I feel fine.

I want to thank you very much for all you did for me. I kinda figured that if it wasn’t for you I proble wouldn’t be here. I really do thank you & your asst.

Yours very truly,
W.B. White

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