Medical Jurisprudence And Toxicology

ABDOMEN 271

through the reflex action on the solar plexus. Post-mortem examination
would reveal nothing except the signs of shock to account for such a sudden
death.

Wounds of the abdomen are produced by a cutting or stabbing
instrument, by a firearm, by the horns or claws of an animal, or by a fall on
an iron railing or on a sharp projecting point. They are of two kinds, non-
penetrating and penetrating. Non-penetrating wounds are usually simple
and heal rapidly, but may be serious from haemorrhage from some large
blood-vessel, such as the epigastric artery, or from septic infection, which,
extending to the deeper tissues, may involve the peritoneum and cause
peritonitis. A ventral hernia may sometimes occur from the cicatrix left
after the healing of the wound.

Penetrating wounds are, as a rule, dangerous, and may cause death
immediately from shock or internal haemorrhage, or subsequently from
septic peritonitis. They may occur with or without injury or protrusion of
the abdominal viscera. Those wounds in which the subjacent viscera are
not damaged usually heal readily, unless they are extensive and the
abdominal contents are exposed to the air.

Stomach.—The stomach, especially when distended with food or diseased
from ulcer or cancer, may be easily bruised or even ruptured by a blunt
weapon, a crush or a fall on the epigastrium, without leaving any mark of
external injury on the abdominal wall. The pyloric end and the greater
curvature of the stomach are the usual sites of rupture.

At 10 a.m. on the 6th October 1923, a boy, 8 years old, was run over by a carriage
and died immediately. On post-mortem examination there was no external mark of
injury but on opening the abdomen the peritoneal cavity was found to contain a dirty
reddish fluid consisting of undigested rice; the stomach was found ruptured across its
lower border and greater curvature, half an inch above the pyloric end.

It should be borne in mind that its spontaneous rupture may occur when
there is an ulcer in the stomach or sometimes even when there is no
evidence of disease. Thus, Rejthar35 reports the case of a married woman,
aged 67 years, in whom the stomach was ruptured in the anterior wall fairly
close to the lesser curvature and near the cardia. The rupture was in the
form of a linear slit V long, running parallel to the lesser curvature. The
edges were clean-cut and paper-thin, and there appeared to be no local
pathological lesion. There was no evidence of acute or chronic inflamma-
tion, necrosis, previous scarring or adhesions. The woman was suffering
from pyloric stenosis due to a gastric ulcer associated with spasm of the
cardia. There was also dilatation of the stomach. An operation was
performed and the woman made an uneventful recovery.

Penetrating or stabbing wounds of the stomach are generally fatal, and
very often involve the adjoining viscera, such as the liver or spleen.

On the 23rd October 1921, a Hindu male was wounded in the stomach, and he died
on the 26th October. A penetrating wound passed through the stomach into the right
lobe of the liver.—Oudh J. C. Court, Cr. App. Reg. No. 2, 1921.

Intestines.—Rupture of the intestines occurs frequently from violent
blows, kicks, falls, crushes or compressions. In many cases no mark of
injury on the abdominal wall is visible, though in addition to the rupture a
great deal of contusion and laceration of the intestines may be present.
Like the stomach the intestines may rupture spontaneously from chronic
ulceration or from very slight force, if they are diseased or distended.
Moir36 described a case where a patient sustained a rupture of the small
intestine 3| feet frojm the ileo-csecal valve when he attempted to reduce an
inguinal herina by using considerable force.

35. Brit. Med. Jour., Aug. 9, 1952, p. 324.

36. Brit. Med. Jour., Oct. 8, 1921, p. 563.