On traumatic Subcutaneous Injury of Gastro-entro Tracts

In the last few years, accidental injuries have greatly increased as a result of the progress of the mechanisation of urban industry. Recently I observed the cases of two patients suffering from unusual subcutaneous intestinal injuries caused by similar accidents. They had been caught in machines by their sleeves and belts, so that the latter which were made of leather severely squeezed their loins. Both patients were labouring men, strong, healthy and young and had climbed up to oil their machines when they were accidentally caught in the mechanism and saved themselves only by desperate efforts. One of them tore off the belt by himself and just managed to get down and was brought to our clinic. The other hung on and called out to his mates to stop the machine and was then brought down and carried by them to our clinic. The first case, aged 37, was seen six hours after the accident, when internal hemorrhage and peritonitis, caused by ruptured intestines were diagnosed. An operation was performed and it was found that the abdominal cavity was full of blood with a little gas while the jejunal tract was sharply amputated at a point 40cms. from the duodenojejunal flexure, and its mesentery was torn right up to the radix mesenterii, and was bleeding freely from the bottom; the serosa of ileum was torn in two places, about 20cms. from the ileocaecal valve and the serosa and mucosa of the caecum and the descending colon were also torn for about 5cms.; two retroperitoneal haematoma were found but no connection with any other organs could be found. Unfortunately the patient died seven days after the operation, as a result of general complications, in spite of every precaution. The second case, aged 26, was examined and subcutaneous rupture of the intestinal tract was diagnosed and an operation performed several hours later. To our surprise, three pieces of the Ushaped loops of the ileum, each about 10cms. long, were cut off sharply, as thouth amputated with a knife, at points 1 metre distant from the ileocaecal valve. The serosa of the sigmoid flexure was also torn in three places, each rupture being about 4 to 5cms. long. The post operative convalesence was uneventful. According to established theory, subcutaneous injuries of the gastro-entero tracts are classified as contusion, rupture and avulsion, which last is caused by pulling action. But in these observations and after experimental investigations with animals, I have come to the conclusion that traction cannot always effect the tearing off of the intestinal tract, which has very great extensibility and it is almost impossible to exert tractive action upon it, as it is with minor exceptions, quite free in the abdominal cavity. On the other hand, if compressive and frictional action be exerted on the tract against the hard vertebral column or ileacal bone, it may be easily amputated, as has been shown in my experiments with animals. In these cases, the patients struggled with the desperate efforts of powerful young men, to extricate themselves from the moving machines, which squeezed their loins by the strong leather belts, and this must have caused, in the second case, the several rows of U-shaped loops of gut to be intersected in the middle by the action of friction and compression between the belt and vertebral column, so that they were amputated into three pieces about 10cms. long. (See Fig. 2). In the first case, the amputation of the jeual tract may have been caused by the same thing. I therefore conclude that it would be better to call this, “traumatic subcutaneous amputation of the intestinal tract” rather than “traumatic subcutaneous avulsion of the intestinal tract”.