294. Thoraco-Abdominal Through-and-Through GSW with Severe Fore-Arm Damage

Nemeth, John J., Pvt.	35927346	Age 19	‘M’ Co 255th Inf.
Injured	1100 hrs.	15 Feb 45	G.S. Wds
Field (Weiswiller)	1300 hrs.		M.S. gr 1/4 500 cc plasma
363rd Coll Co ‘C’	1530 hrs		M.S. gr 1/4
363rd Med Bn Clr CO A	1620 hrs.
10th Field Hosp.	1635 hrs.

Gen’l condition on admission poor. B.P. 80/- P. 160. Abd. tender and rigid ++++. B.S. heard over left side of chest. P.M.I. in normal position. Right arm & forearm in splint. Two pen wds rt upper quadrant. Two F.B.’s in subq. position posterior axillary line at 5th & 7th ribs on left side. Severe perf. lac. wd of right forearm & hand.

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Diagnosis: G.S.W., two, thoracoabdominal left sv. GSW perf & lac forearm & hand right sv. F.C.C. ulna right severe, F.C.C. 2nd metacarpal rt., shock secondary.

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Preop Rx

1645 hrs.	B.P. 80/40	P. 160	Plasma 500 cc
1730 hrs.			20,000 units Penicillin. Urine neg.
1745 hrs.	B.P. 112/80
1900 hrs.			500 cc blood #91 "O" 2/4
1905 hrs.			1 cc T.T.
1910 hrs.	B.P. 120/80	P. 164
1935 hrs.	B.P. 120/80	P. 164	Xray showed two fb's--in a subcutaneous position at 5th & 7th ribs in posterior axillary line on left side. Xray of chest revealed left lung to be expanded.

Operation

2020 hrs.	B.P. 110/80	P. 154	Endotracheal E & O2. 200 cc plasma & N.S. & G. 1000 cc
2100 hrs.	B.P. 100/60	P. 150	Operation started. Plasma 200 cc.
2130 hrs.	B.P. 110/60	P. 140	Plasma 250 cc
2150 hrs.	B.P. 110/60	P. 148	Blood.
2230 hrs.	B.P. 110/60	P. 152	B1 20 mg into N.S. & G.
2300 hrs.	B.P. 110/60	P. 156	B1 50 mg into N.S. & G.
2330 hrs.	B.P. 104/60	P. 152
2400 hrs.	B.P. 100/60	P. 160
2430 hrs.	B.P. 80/40	P. 160	100,000 units Penicillin in N.S. & G.
2445 hrs.	B.P. 90/50	P. 160	End of operation.

Laparotomy thru high left rectus muscle splitting incision. Considerable free blood , small and large bowel contents in peritoneal cavity. 7 perforations of jejunum and ileum (14 holes). Three of these were within first 6 inches of jejunum. Perforations closed. Two perforations of duodenum (one on free surface; one retroperitoneal)--closed. There was a large rent in the transverse mesocolon at its root--blood supply intact. Rent closed. Two perforations of diaphragm medial to spleen high on posterior surface of diaphragm closed. These were sucking. Spleen & stomach neg. Two perforations of transverse colon at mid portion--loop colostomy formed and delivered thru right subcostal stab wd. Exam of pelvis neg. 10 gms. sulf to peritoneal cavity. 5 retention sutures thru all layers. Wds of entrance & exit to right of mid line debrided. Two f.b.’s removed from left chest wall at 5th & 7th ribs. Wds sucked. Closed. Chest aspirated. 300 cc blood recovered. Lung brought out to chest wall. Intercostal catheter inserted in 3rd interspace left & connected to water trap. Wds of right forearm & hand debrided. 1 ½ inches of ulna blown out. Median N. incompletely lacerated. Radial A & V intact--pulsated in wd. Ulnar N. blown out. Perf. wd of hand debrided. Dry gauze dressings. Long arm plaster splint. (500 cc blood post op).

18 Feb.	T. 102. Colostomy putting out this a.m. 500 cc blood.
20 Feb.	R.B.C. 3.7 Hb 65%. Thoracentesis, left--no recovery.
21 Feb.	Colostomy putting out formed feces. Semi soft diet. 500 cc blood.
23 Feb.	Thoracentesis = 0 fluid. Xray shows left lung fairly well expanded.
24 Feb.	500 cc blood. Colostomy working well. Still runs fever (102).
2 Mar.	Large abscess [lower] pole incision. T. to 99. Much improved.
3 Mar.	Arm cast changed. Wd clean. Evacuated in fair condition.

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