[Reprinted from The Medical News, April 14, 1894.] 
AN UNUSUAL ACCIDENT AFTER CELIOTOMY. 
By E. H. KING, M.D., 
OF MUSCATINE, IOWA. 
In a celiotomy performed during the past year, the 
abdominal stitches—silkworm-gut—were removed on the 
eighth day, primary adhesion of the wound having 
occurred without suppuration. There had been per- 
sistent ether-nausea from the time of the operation. No 
opiates had been used. The bowels had been freely 
opened on the third day by enemata and salines. There 
was no distention of the abdomen and but slightly 
elevated temperature. 
On the evening of the ninth day violent nausea, 
retching, and straining occurred, when two-thirds of the 
extent—about three inches—of the wound were torn 
open, allowing a part of the colon and omentum and a 
mass of small intestines to escape. I found the patient 
in extreme mental and physical shock. The protruding 
viscera were covered and protected by a towel wrung 
out of hot water until an assistant could be obtained, 
when they were returned within the abdomen and the 
peritoneum secured by fine catgut, and the parietal tissues 
with silkworm-gut sutures, all without anesthesia. Drain- 
age was provided for by a small roll of iodoform-gauze. 
At the conclusion of the operation the patient’s pulse 
was too weak and rapid to be counted ; she was in great 
pain, and very restless. Free use of morphin, atropin, 
and strychnin was made, and enemata of hot beef-juice 
and whiskey were given. This was kept up at regular 
intervals for forty-eight hours, without any perceptible 2 
effect save to relieve pain, nausea, and restlessness; but 
after this the pulse began to increase in volume and de- 
crease in frequency. The peritoneum united primarily 
and the parietal tissues secondarily, with but slight and 
superficial suppuration. The patient made a slow but 
good recovery. There is at present a small linear cica- 
trix, with no tendency to hernia. 
It occurs to me, in view of the possibility of such an 
accident, that in clean celiotomies—that is, in operations 
in which the wound can be completely closed without 
the necessity of drainage—it would be a safeguard to 
fasten the omentum to the abdomen behind the incision, 
securing it by a stitch at the lower end of the wound, 
where by adhesion it would be interposed between the 
viscera and the weakened part of the abdominal wall, 
thereby reinforcing and strengthening it.