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JAMA 100 Years Ago
August 6, 2003

Gunshot Wounds.Gunshot Wounds.

JAMA. 2003;290(5):678. doi:10.1001/jama.290.5.678-a

CURRENT MEDICAL LITERATURE.—Vaughan classifies gunshot wounds into two classes—with or without peritonitis. In the first class, if there is no extravasation of the visceral contents, neither irrigation or drainage is required, but if there is extravasation of the visceral contents, thorough cleansing of the peritoneal cavity is necessary and, unless the operator is satisfied that the cleansing is perfect, drainage should be used from the most dependent part—in the female in the vagina and in the male perhaps by tapping the rectovesical peritoneal pouch by an opening into the perineum between the rectum and the urethra. When the wounds are few, extravasation limited and operation performed early, cleansing by sponging and local drainage may be all that is required. After severe hemorrhage with the formation of blood clots or if there has been imperfect hemostasis, irrigation is indicated as the bloody fluid would form too good a culture medium for germs. In case of local peritonitis the parts involved should be drained, but irrigation should be used with caution to avoid infection of other parts. Generally it is advisable to simply provide drainage. In general peritonitis there is little to be done, but the patient should be given the chance of life by thorough irrigation and efficient drainage in the manner described. (1903;41:747-748)

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