Source: Boston Medical and Surgical Journal
Source type: journal
Document type: article
Document title: “Gunshot and Bayonnette Wounds of the Stomach”
Author(s): Cumston, Charles Greene
Date of publication: 15 October 1914
Volume number: 171
Issue number: 16
Pagination: 591-95 (excerpt below includes only pages 594-95)
|Cumston, Charles Greene. “Gunshot and Bayonnette Wounds of the Stomach.” Boston Medical and Surgical Journal 15 Oct. 1914 v171n16: pp. 591-95.|
|William McKinley (surgery).|
“A paper compiled from lecture notes on The Surgery of War” (p. 591).
“By Charles Greene Cumston, M.D., Geneva, Switzerland. Privat-Docent [sic] at the Faculty of Medicine of the University of Geneva; Fellow of the Royal Society of Medicine (Lond.); Honorary Member of the Surgical Society of Belgium” (p. 591).
Gunshot and Bayonnette Wounds of the Stomach [excerpt]
In some special cases extragastric exploration
will be insufficient, in which case gastrotomy is to be resorted to, but before
doing this a cushion should be placed under the lumbar region, which may render
the examination easier and the endogastric procedure may not be required. However,
should this be deemed necessary, the incision in the anterior gastric wall should
be horizontal, at least three inches long, and made at equal distance from the
curvatures. Introducing the hand behind the stomach, the posterior wall is made
to protrude through the gastric incision. The mucosa is wiped with compresses,
after which the surface is examined. One may thus discover an ecchy- 
mosis or a perforation which would otherwise have been overlooked.
This technic, which in gastric ulcer is rather simple, is less so in traumatic perforation, because in the former the gastric cavity is apt to be empty, while very frequently the stomach is full at the time the gunshot injury is received. This being the case, the contents must be removed through the incision, with all due care not to let any of it escape into the peritoneal cavity. Very few surgeons have resorted to endogastric exploration in gunshot wounds, and when it has been done, the incision in the anterior wall has been timidly made, with the result that the posterior perforation has been overlooked. In the case of President McKinley, the anterior perforation was simply enlarged and the gastric cavity explored with the finger, and the posterior perforation was only discovered by a direct examination of the posterior wall.