277. “Eviscerated but he’ll do all right.”
Gen’l condition on admission fair. B.P. 120/70. Approximately 3 feet of small bowel were herniating through left abdominal wound. One small perforation in loop of ileum. Abd. rigid and tender ++++. Urine clear.
Diagnosis: S.F.W. pen. and perf. abdominal wall, left and right thighs. Evisceration.
Preoperative Rx
| 1745 hrs. |
500 cc plasma |
| 1805 hrs. |
500 cc plasma |
| 1845 hrs. |
500 cc plasma. Urine clear. Xray shows large F.B. in abdominal wall at upper end of incision. |
Operation
| 1920 hrs. |
B.P. 140/70 |
P. 136 |
Endotracheal E & O2 |
| 2010 hrs. |
B.P. 80/40 |
P. 100 |
Operation started. |
| 2045 hrs. |
B.P. 82/46 |
P. 104 |
|
| 2100 hrs. |
B.P. 84/50 |
P. 100 |
|
| 2105 hrs. |
B.P. 98/54 |
P. 104 |
|
| 2130 hrs. |
B.P. 90/50 |
P. 96 |
500 cc blood. |
| 2145 hrs. |
B.P. 120/60 |
P. 104 |
Operation ended. |
Abdomen prepped and presenting bowel was cleaned with warm N. saline. One exteriorized loop was perforated. All but this loop returned to peritoneal cavity. Abd. redraped. Perf. closed. Peritoneal cavity packed off and wd. debrided. There was extensive fascia and muscle loss--internal oblique, left rectus muscles extensively damaged. Fascia of external oblique also was severely lacerated. Largest of 3 F.B.’s removed from abdominal wall at upper end of incision. Wd. was greatly contaminated by clothing and other debris. Abd. explored. Neg. except for the one perf. of ileum. 10 gms. sulf into peritoneal cavity. Retention sutures thru all layers. Abd. closed in layers with catgut as tissues would permit. Two penrose drains to wd. Retention sutures tied over rubber tubes. Perf. wd. left thigh debrided. Tract contained clothing bits. Tract irrigated with normal saline. Pen. wd right thigh debrided. F.B. removed. Pen. wd at left ant. sup. iliac spine debrided. F.B. removed. Incomplete fracture of ilium here. Condition good at end of op.
| Jan 14 |
Wd dressed. Appears clean. T 99. |
| Jan 17 |
Wd redressed. Wds are clean. Retention suture not tight. |
| Jan 20 |
Evacuated. Condition good. |
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Battlefield Surgeon