Penetrating or perforating wounds are presumed to have entered the peritoneal cavity unless it is proved otherwise. Usually, multiple organs are involved in missile wounds, and the injury may be anticipated by plotting the tract as a straight line from entrance to the site of lodgment or exit. The mechanisms of injury following blunt trauma are principally compression and shearing from attachments. Wounds of the stomach are simply closed. Injuries of the small intestine are closed or treated by resection and anastomosis where necessary. Injuries of the colon are treated by exteriorization or by repair and proximal diverting colostomy, depending on the site and extent of injury. Trauma of the cecum or ascending colon is a problem which requires individualization, depending on the site and extent of involvement in a given patient. The gallbladder is surgically removed when injured, and the common duct drained with a T-tube.
Tripler Army Hospital