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DIAGNOSIS AND OPERATIVE TREATMENT OF GUNSHOT WOUNDS OF THE STOMACH AND INTESTINES.Read by Invitation in the Surgical Section of the Tenth International Medical Congress, August 8, 1890.

N. SENN, M.D., Ph.D.
JAMA. 1890;XV(9):311-320. doi:10.1001/jama.1890.02410350007001c.
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The existence of a visceral lesion of the stomach or intestines must be suspected in every case where a bullet penetrates the abdominal cavity ; hence the first step in the diagnosis of gunshot injuries of these organs must be directed towards establishing the fact that penetration has occurred.

DIFFERENTIAL DIAGNOSIS BETWEEN NON-PENETRATING AND PENETRATING GUNSHOT WOUNDS OF THE ABDOMEN.

This part of the diagnosis may be easy or difficult, according to circumstances. If the bullet has passed through the body, and the wounds of entrance and exit occupy such positions that a direct line connecting them will necessarily pass through the abdominal cavity, there can be but little doubt that both abdominal walls have been perforated at opposite points, and that the bullet has traversed that part of the peritoneal cavity interposed between them. In obese persons, the exact outlines of the peritoneal cavity cannot be located with absolute

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