The Case of the Wounded Woodsman and His Dedicated Physician

Albert B. Lowenfels, MD

Disclosures

September 02, 2009

The Case

The patient was a 28-year-old, healthy itinerant laborer who was accidentally shot at close range by a companion. The shell entered the left anterolateral side of his body a few inches below the left nipple. The patient fell to the ground but remained conscious. A physician who examined the patient shortly after the accident noted a large wound of entry about the size of a man's hand, but no wound of exit. The left lung protruded through the opening along with a portion of the stomach, with an opening caused by the bullet. Several adjacent ribs had been fractured. Food from a recent meal was present in the wound.

In describing the patient's injury, his physician wrote: "I considered any attempt to save his life entirely useless." Nevertheless, his physician debrided the wound, replaced the protruding stomach and lung, and applied a protective dressing. On the following day, the patient developed fever, a cough, and had evidence of pneumonia. For the next week, the patient continued to be febrile; the wound became infected; and the patient was fed rectally.

To the physician's surprise, over the next several weeks the patient's condition gradually improved, although the gastric wound never completely closed. Nevertheless, he could tolerate oral feedings if the gastric opening was occluded with a compressive dressing. Over the next year, the patient's strength gradually returned to normal, but the gastric wound refused to close. The physician made an arrangement with the patient to follow him more closely and to study his gastric physiology; these studies continued intermittently over the course of many years.

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