Wounds of the abdomen. Part 1: In war

Until the turn of the 20th century, penetrating wounds of the abdomen in war were treated conservatively, with a very high death rate. Survivors were those who recovered from or escaped hemorrhage and shock, were fortunate enough to avoid vital organ injury and lived in spite of wounds of the viscera complicated by a high incidence of sepsis. Laparotomy could not be justified as the treatment of choice until World War I when anesthesia, intravenous administration of fluids, blood for transfusion and antisepsis were available. Even so, death rates at the close of that war were 60%. It has become increasingly apparent with each successive war that the progressive reduction in morbidity and mortality in penetrating abdominal wounds depends not only on the quality of the surgery but also on advanced life support on the battlefield and early, direct evacuation to field hospitals where intensive resuscitation, skilled anesthesia and comprehensive postoperative care are available.