NOTES OF A CASE OF TRAUMATIC HERNIA OF THE DIAPHRAGM PROVING FATAL SEVEN MONTHS AFTER THE WOUND

C SYMONDS
1917 The Lancet  
Royal Army iMedi~alCorp8. ' PTE. D., of the S.A.L, aged 29, was ad~itted to the Connaught Hospit~lon the afternoon of August 31, with the following history:~ Having h~d no previous illness and led a vigorous and healthy life, he was wounded in February,' 1916, whilst fighting against the Seriussi. He was stooping forward when hit, so that the bullet, which entered over the left lscap~la, apparently came to" rest in the ,subcutaneous tissues of the abdominal wall in the left hYPoc,hondrium. He
more » ... YPoc,hondrium. He was taken to a dressing station where he vomited some blood, and subsequently to a basehoispital, at which an operation was performed on his abdomen, and he believe~the bullet was removed. Both wo.und·s ",ere healed in ten days; he was, kept in bed for' five weeks,became restored ,to full health and,was eventually discharged to ~~. ' About six weeks after the original wound he had his first attack of abdominal pain;' it was very slight, and lie did not take much notice ~f it. Subsequently he had m~~y such attacks-three or four a month, . latterly they had become more, severe, but he' had not felt ill enough to report sick. He had observed tbat the attac~s were nearly always preceded by constipation; he then had a premonitory feeling of uneasiness in the abdomen, and if he could now get his bowels to open well could sometimes avert the atta:ck. The pain came on after, or half;way through a meal, and would pass off in a few minutes', being relieved' when he lay on 'his right side; while it lasted i~ was very severe, but in between the attacks he' felt quite well, though he thought his wind was not as good as it had been. " ' " He 'was admitted in what he described asa typical attack, but much more severe than i1ny before' experienced. His bowels had not' been , open for t~o days, and then half way through breakfast had come on the pain; he .vomited the. food just taken, but with no relief. Un examination he' proved ,to be a well developed man of normal physique; over the centre of the spine of the left scapula was the scar of the entrance wound; in the middle of the left hypoehon,drium. was a healed, two-inch linear incision.' . . ' He complained of a dtill, continuous pain across the upper abdomen, to ,'which were added .. occasional 'paroxysms of agony, during which he turned pale and cold, and broke out into a sweat, while"his pulse was· small, slow, and irregular; the position he adopted during these paroxysms was very stri~ing, sitting bolt upright with his knees, huddled uP. to his. chin, the slightest attempt at straightening the ,back being intolerabl~. , '
doi:10.1016/s0140-6736(01)14549-6 fatcat:ptuh6b7cmfbv3iebtut2lkli7i