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324
THE BRITISH JOURNAL O F SURGERY
SHORT
RARE
OR
NOTES
OBSCURE
OF
CASES.
A CASE OF GUNSHOT INJURY OF MECKEL’S DIVERTICULUM.
BY MAJOR GORDON TAYLOR, R.A.M.C. (T.C.)
PTE. W. G. E., was admitted into a casualty clearing station in the spring of 1918
with a shell wound of the right buttock, but with obvious signs and symptoms of a
penetrating injury of the abdomen ; he had been hit six hours before.
The missile was found t o have entered the right buttock, and t o have opened the
right side of the perineal portion of the rectum about two and a half inches from the
a n u s ; it had entered the right infero-lateral and extra-peritoneal wall of the bladder,
and emerged from the peritoneal surface of this viscus a t the junction of the superior
surface and the base. The track between the rectum and the buttock was laid
widely open, and the sphincter divided. The wound of the peritoneal surface of the
bladder was excised, and the edges
were sutured with catgut ; the cavum
Retzii was drained with a piece of
rubber sheeting.
There were sixteen perforations
of the ileum, and several holes in
the mesentery ; two of the wounds
in the bowel were along the mesenteric attachment. There were also
two small wounds in a Meckel’s
diverticulum which was present. It
was deemed necessary t o resect the
damaged portion of the ileum, and
the resection was extended downwards so as t o include the portion
of bowel t o which the diverticulum
FIG. “95.
was attached ; three-and-a-half feet
of small intestine were removed, and
an end-to-end junction was made. The Meckel was rather under one inch in length,
and somewhat tri-lobed at the end ; the missile had perforated it near the distal end
(Fig.295). I n spite of the severity of his injuries, the patient made a good recovery,
and was evacuated t o the base eleven days after operation; five weeks later a satisfactory account of his progress was obtained.
The injury cannot be a very common one, and the case therefore seems worthy
of record.
I am indebted t o my friend and colleague, Captain H. T. Andrew, R.A.M.C., for
the sketch which accompanies this note, and t o Colonel L’Estrange, R.A.M.C., for permission t o publish the notes of the case.