The Thoraco-Abdominal Casualty

Abstract

THE SCOPE OF THIS REPORr is a disctussion of the thoraco-abdominal casualty in the Forward Hospital, with a presentation of the available data fromll 903 case records of the 2nd Auxiliary Surgical Group during I943, I944 and 1945. The thoraco-abdominal wound is defined in this report as a wound produced by a missile perforating the diaphragm with entrance into the pleural and peritoneal cavities. Casualties, in which the pleural cavity and peritoneum have been entered by separate missiles without injury to the diaphragm, have leen excluded. However, a wound of the so-called "bare area" of the liver, incurred by a fragment entering through the chest and diaphragm has been considered a true thoraco-abdominal wound. A comparison of the incidence of the thoraco-abdominal wound with respect to all abdominal wounds is of interest. During the period covered by this report, 3,532 operations uponl abdominal wounds of all types were performed. The thoraco-abdoninlal wound comiprised 25.5%o of this group of abdomiiinal cases. The great majority of casualties presented are Infantrymen of the U. S. Army and of the Wehrmiiacht, with a scattered number of Allied British and French soldiers, and a few civilians. The age factor, then, is of little significance, because, of necessity these miien were in the young healthy adult male group.

Ballistic Thoracoabdominal Injury: Analysis of Recent Military Experience in Afghanistan

“…During the World War II, 10% to 28% of gunshot wounds to the chest were found to involve abdominal viscera [4][5][6], rising to 27% to 35% [7,8] during the conflicts in Korea and Vietnam, respectively. Mixed military and civilian populations from the conflicts in Lebanon and the Balkans identified, respectively, 55% and 17% of thoracic war injuries associated with abdominal involvement [9,10].…”

Incidência de fístulas digestivas nos ferimentos toracoabdominais

“…As lesões de vísceras ocas que, freqüentemente, acompanham estes ferimentos, podem ocasionar contaminação da cavidade peritonial com possibilidade de estender-se ao espaço pleural. 1,2,3 Assim, nestes pacientes, não é rara a ocorrência de deiscência da sutura dos órgãos intra-abdominais atingidos, que leva ao aparecimento de fístulas digestivas, com graves repercussões hidreletrolíticas e nutricionais, responsáveis por elevadas taxas de morbidade e mortalidade. 4,5 As controvérsias quanto ao tratamento são compreensíveis, dadas as dificuldades, já referidas, relativas ao diagnóstico correto.…”