[Reprinted from The Medical News, July 23, 1898.] 
GUNSHOT WOUND OF THE ABDOMEN: TEN 
INTESTIN AL PERFORATIONS AND TWELVE 
PERFOR AT! ON S OF THE MESENTERY; 
OPERATION; RECOVERY. 
GEORGE TULLY VAUGHAN, M.D.. 
OP WASHINGTON, D. 
PASSED-ASSISTANT SURGEON, UNITED STATES MARINE HOSPITAL 
SERVICE; PROFESSOR OF PRINCIPLES AND PRACTICE OF 
SURGERY IN GEORGETOWN UNIVERSITY. 
G. A. F., white, male, aged thirty-one years, native of 
Virginia, was admitted to the Emergency Hospital dur- 
ing the night of May 26, 1898, having just been shot in 
the abdomen with a pistol. When seen by me, a little 
more than one hour after the shooting, his condition was 
very good. Pulse 84; temperature not taken; there was 
no nausea, vomiting, or evidence of shock; but the pa- 
tient complained of severe paroxysms of pain in the abdo- 
men. The wound was in the left side of the abdomen, 
about two centimeters of an inch) above the center of 
a line drawn from the navel to the anterior superior spin- 
ous process of the ilium, but a little nearer the navel. 
Blood was oozing steadily from the wound. It was im- 
possible to decide from the symptoms present whether or 
not the viscera had been injured. Injections per rectum 
of gas or water were not made use of on account of the 
danger of forcing intestinal contents into the peritoneal 
cavity in case the intestine had been wounded. It was 
thought safer and more satisfactory to explore the wound 
with probe and finger, enlarging it as might be necessary 
for this purpose. 
The patient having been chloroformed and the surface 
carefully cleansed as if for abdominal section, attempts 
were made to introduce a probe into the peritoneal cav- ity, but the effort failed, probably owing to the muscles 
having been contracted when perforated, their subse- 
quent relaxation interposing sound tissue across the track 
of the ball. Accordingly the probe was introduced as 
deep as it would enter and the tissues were divided to this 
depth for a space of about six centimeters (2X inches). 
The probe was then introduced at a different angle and 
the tissues again divided, when it was found that the 
probe entered the peritoneal cavity, its entrance being fol- 
lowed by a free discharge of blood. The incision in the 
skin and muscles was rapidly extended to about thirteen 
centimeters inches) and the peritoneum incised, 
blood flowing freely from the cavity. 
The first coil of intestine which presented was drawn 
carefully through the wound and examined. Not more 
than ten centimeters had been thus drawn out before a 
perforation was found, there being two openings, one of 
entrance and the other of exit. These were closed and 
further search made, the coils of intestine being sur- 
rounded by flannel cloths wrung out of hot salt solution 
and replaced at one end while they were being drawn out 
at the other. Eight openings were found in what was 
thought to be the lower part of the jejunum and two in the 
ileum. There were six perforations of the mesentery, or 
twelve openings in all, the wounds of entrance and exit in 
the mesentery being closed separately. The ten perfo- 
rations of the intestine and twelve of the mesentery made 
a total of twenty-two openings. Twenty of these open- 
ings were closed by sutures; two in the mesentery were 
not bleeding and were passed over. A round sewing 
needle with fine silk was used, the mattrass suture intro- 
duced including simply the serous and subserous tissues 
exclusive of mucous membrane, thus approximating the 
serous surfaces. The line of sutures was transverse to 
the long axis of the intestine. The wounds in the mes- 
entery were closed in the same way. In a few of the 3 
large wounds of the intestine, where the ball had evidently 
cut through the convex border of the gut, making a sin- 
gle, very ragged, large opening, instead of two small 
openings, two sets of sutures where used, the first to ap- 
proximate the edges, and the second, the mattrass suture 
as already mentioned. In all other places a single row 
of sutures was used, the threads being placed about half 
a centimeter apart (five to an inch). The bleeding was 
chiefly from the mesentery and the vessels were controlled 
by the sutures. There was about half a pint of blood in 
the abdominal cavity. The ball, a .38-caliber, was found 
wrapped in a portion of the great omentum. It was not 
scarred or flattened, evidently not having struck a bone or 
other hard object. 
Fortunately the portion of intestine wounded, included 
in a length of about two meters of the jejunum and ileum, 
was empty of fecal matter and none was detected in the 
peritoneal cavity; but the cavity was thoroughly irrigated 
with about 10,000 cubic centimeters of warm salt solu- 
tion. The entire length of the small intestine was exam- 
ined by sight and the large intestine, stomach, kidneys, 
liver, and spleen by palpation. The wound in the abdo- 
men was closed by means of interrupted silkworm-gut su- 
tures, including skin, muscle and peritoneum, without 
drainage. Pulse 124 at close of the operation, which 
lasted 2Yz hours. The patient suffered considerable pain 
on recovering from the anesthetic (chloroform) and was 
given .015 gram (approximately X of a grain) of mor- 
phin hypodermatically. 
May 27th. Patient slept very little; is nauseated. Or- 
dered sulphate of magnesia, four grams (60 grains) every 
hour until bowels should act. After taking two ounces 
the bowels moved four or five times and the nausea and 
other symptoms improved. Temperature, in axilla, 
38° C. (ioo° F.), both morning and evening. Pulse 120 
in morning, 104 in evening. May 28th. Temperature 4 
37-2° C. in morning, 37.4° C. evening. Pulse 104 in 
morning and evening. May 29th. Temperature 370 C. 
(98° F.); pulse 80. After this the pulse and tempera- 
ture were practically normal; once for some unknown 
reason the temperature rose to 38.8° C. The patient 
had no opiates after the 29th. June 10th. First dress- 
ing; stitches removed. There was primary union 
throughout except at the point of entrance of the bullet 
and a short distance below, both of which were covered 
by small scabs. A few drops of pus exuded where some 
of the sutures passed through the skin. June 12th. 
Patient allowed to get up, abdomen being well supported 
by a flannel bandage. June 19th. Patient walking 
about; still small scabs over the two points mentioned. 
June 24th. Patient well; appetite good, bowels act 
fairly well, occasionally requiring salts or an enema. 
Complains of a little stiffness about the wound. Dis- 
charged from treatment.