| Case Report of an Interesting Gunshot Wound |
| A.H
Osborne |
| Journal of the
Royal Naval Medical Services Vol 64 Summer 1978 |
| |
| The article describes
the treatment of a member of the Muscat Regiment who fell
fifteen feet into a wadi. The SMG that he was carrying
discharged two rounds one of which entered his abdomen. |
| |
| He was evacuated by
landrover over rough ground for three hours then onto a tarmac
road where a helicopter met him and flew him to the "55th Joint
Services Field Surgical Team" |
| |
| He was found to have a
faecal peritonitis from a perforated and both liver and kidney
damage. Peritoneal toilet was effected along with some bowel
resection. |
| |
| Post operatively at 24rs
he had a RLL collapse and a large plug of mucous was removed
with a bronchoscope. |
| |
| By 36hrs he had developed
a complete quadriplegia (?) from spinal concussion as X-Rays
showed no spinal injury. |
| |
| The colostomy functioned on
the fourth day. |
| |
| DPS was carried out to
entry and exit wounds on the 14th day. |
| |
| Neurological recovery was
partial. |
| |
| Retention occurred after
removal of his catheter and bladder tone was restored by
recatheterisation and intermittent clamping. |
| |
| A right hemi-colectomy
was performed at seven weeks and the colostomy was closed. |
| |
| Bowels opened on the
fifth day. |
| |
| Small amounts of clear
urine were noted to be leaking from the Yeats drain site on the
ninth postoperative day and an IVP showed a small sinus from the
upper calyx of the right kidney to the abdominal surface. It
resolved by the 14th day and was considered to have been caused
by damage which occurred when the hepatic angle of the ascending
colon was mobilised. |
| |
| Three months after injury
further neurological improvement had occurred and he could walk
with a stick. There was improved bladder tone and his bowels
opened regularly twice a day. |
| |
| In discussion Mr Osborne
makes the following observations |
|
- resuscitation
was hampered by the limited availability of intravenous
solutions
- no
conventional blood bank was available and it was only
expatriate donors who were prepared to give blood at an
hours notice. 15% of these had been incorrectly typed and
their blood was thrown away as it could not be stored
- a long median
incision is needed... a smaller incision may lead ultimately
to a missed injury
- "DPS was
delayed from the usual five to fourteen days because of
wound infection"
- colostomy is
required for large bowel injury with the two ends brought
out as separate colostomies 3/4" apart
-
routine
anti-biotic cover should have consisted of benzyl penicillin
1megaunit IV 6hrly and streptomycin 0.5gms bd. However in
this case gentamycin 80mgs iv was given instead of the
streptomycin on account of the widespread faecal
contamination. IV ampicillin was unavailable at the time
(It looks as supply was still a problem even late in the
existence of this FST. One might have thought that proper and
effective supply might have been established this late in the
day - FWJdeB) |
| |
| |
| |
| |
