About one inch of the harpoon was seen
protruding from below the tip of the ensiform cartilage; the
harpoon was seven inches long. It was found that the instrument
had penetrated the right lobe of the liver; on passing the hand
backward along the inferior surface of the liver, the point could
be felt projecting through its posterior border. On account of
two sharp barbs on the spear-point, it was necessary to push the
harpoon further in to disengage the barbs, after which it was
easily removed. Recovery followed, and the patient was discharged
in twenty-one days.
Romme discusses the subject of punctured wounds of the liver, as
a special text using the case of the late President Carnot. He
says that in 543 cases of traumatism of the liver collected by
Elder, 65 were caused by cutting or sharp-pointed instruments. Of
this group, 23 recovered and 42 died. The chief causes of death
were hemorrhage and peritonitis. The principal symptoms of wounds
of the liver, such as traumatic shock, collapse, local and
radiating pains, nausea, vomiting, and respiratory disturbances
were all present in the case of President Carnot. From an
experience gained in the case of the President, Romme strongly
recommends exploratory celiotomy in all penetrating wounds of the
liver.
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