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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(11):389-395. doi:10.1001/jama.1890.02410370013001e.
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(Concluded from p. 363.) 2. Treatment of Gunshot Wounds of the Stomach and Intestines. The propriety of surgical interference in cases of gunshot wounds of the stomach and intestines will depend on one of two things:

1. Dangerous internal haemorrhage.

2. Visceral wounds of the stomach or intestines large enough to permit of extravasation and the escape of hydrogen gas on applying the diagnostic test.

Alarming intraperitoneal hæmorrhage furnishes an urgent indication for treatment by laparotomy irrespective of the existence of the visceral lesions of the gastro-intestinal canal. In these days of aggressive surgery it would indeed be unjustifiable to permit a patient to die slowly but surely from hæmorrhage from an intra-abdominal wound which in itself is amenable to successful treatment by prompt surgical means.

The signs and symptoms of profuse internal hæmorrhage come on soon after the injury has been inflicted, and are so plain and significant


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