Stomach wound recovery

[FishyBiscuits]

Hi all! First-time poster here...

I've been having a look at other threads on similar topics, but I just want to check a few things since I haven't found all the info I need.

Basically, my character (20 years old, male, average physical health) gets a slash wound to the stomach/abdomen by a dragon-like creature (he's not wearing any kind of armour). He's in the middle of a fight so he can't get medical attention straight away. I want the wound to be deep enough to cause significant blood loss pretty quickly (stage 3 hypovolemic shock, progressing into stage 4 - I've got info on the symptoms), but preferably no permanent nerve or muscle damage - though temporary damage is fine (and, I suspect, expected).

The character will get medical treatment in a modern hospital (the story is set in a 2011-ish American-like society), but he needs to be mostly or completely unconscious before he leaves the battlefield. He'll be transported to the hospital on the back of another dragon (there's too much damage to the surroundings for ambulances to get through in time), so he won't be lying flat, but it's not a long flight and there will be pressure on the wound. Ideally, I'd like him to go into cardiac arrest shortly before arriving at the hospital, but I do want him to survive with no serious lasting effects (ie. organ damage), so this can be taken out if it's not realistic.

I don't quite know how deep the wound would need to be for this kind of injury, and I'm not sure on the recovery time and process.

My main questions are:

1. How long would he likely be in surgery, and what kind of state would he be in immediately after surgery?
2. How long would it take for him to be allowed out of bed, and when would he be released from hospital?
3. What sort of nerve/muscle damage might he have to deal with during his recovery?
4. Would it be more realistic for him to have some kind of lasting complications, or can someone make a full recovery from this type of injury?

I hope this makes sense! Thanks guys!

-FB.

 

[Alsikepike]

Well, the recovery time and degree of damage depend on a large variety of things. How deep the wound goes, what direction it came from, what direction it goes to, and the general location. The title implies your character has a hole in his stomach, in which case he probably has about 15 minutes to live. Not 15 minutes to get treatment, 15 minutes to live, period. There's not much you can do once the contents of your stomach mix into your bloodstream.
But, if your talking about an general abdominal wound, your character might have a fighting chance, but you'll need to be more specific to help get a solid answer. I know you want an injury to match your character's situation, but when in comes to recovery, the location and depth matter a lot. Can you give any more detail into how your character is injured?

 

[GeorgeK]

My main questions are:

1. How long would he likely be in surgery, and what kind of state would he be in immediately after surgery?
2. How long would it take for him to be allowed out of bed, and when would he be released from hospital?
3. What sort of nerve/muscle damage might he have to deal with during his recovery?
4. Would it be more realistic for him to have some kind of lasting complications, or can someone make a full recovery from this type of injury?

I hope this makes sense! Thanks guys!

-FB.

1:A long laceration into the rectus abdominus muscle could easily accomplish that without even entering the abdominal cavity. In that case, he'd get transfused and the wound loosely reapproximated or closed with a drain to be removed a few days later. The surgery itself would likely take an hour or so unless there is some caustic substance or terrible shredding such that a lot of debridement were required which might add another hour. They'd also do a couple plain Xrays to look for retained debris. When he woke up he'd be in pain but told to at least get up to a seated position that night and if possible have him walk a bit in the room.
They'd give him pain meds, likely narcotics and if they are a poorly trained surgeon might overdose him, might give him too much so that he's loopy and has no pain. The appropriate level of pain control is enough so that you can walk, not run, not lift anything, just walk slowly. More than that also prolongs ileus (gut paralysis) which is a common side effect of intra abdominal surgery and to a lesser extent any general anesthetic. Once the wound is dry he could shower, likely 2-3 days

2: Discharge requirements would be A: requiring he can do wound care (change the bandage and empty and record drainage volume and color from the drain. B: bowels and bladder working and able to keep fluids and food down (likely 1-3 days)

3:If it's a transverse laceration, probably not much in the way of nerve damage. If vertical, then loss of sensation between the laceration and the abdominal midline. The sensory nerves generally grow approximately an inch per month, so it would depend where on the abdomen the wound is in relation to the midline. Muscle damage (assuming surgical reapproximation and there was no need for aggressive debridement) should heal gradually over 1-3 months depending on severity and whether he can get both adequate rest and do at least walking.

4: No need for permanent problems

 

[GeorgeK]

Well, the recovery time and degree of damage depend on a large variety of things. How deep the wound goes, what direction it came from, what direction it goes to, and the general location. The title implies your character has a hole in his stomach, in which case he probably has about 15 minutes to live. Not 15 minutes to get treatment, 15 minutes to live, period. There's not much you can do once the contents of your stomach mix into your bloodstream.
But, if your talking about an general abdominal wound, your character might have a fighting chance, but you'll need to be more specific to help get a solid answer. I know you want an injury to match your character's situation, but when in comes to recovery, the location and depth matter a lot. Can you give any more detail into how your character is injured?

Unless he were eviscerated, he'd not likely die that quickly. The abdominal wall vessels aren't that big and it would be reasonable with a talon injury that there'd be some vasospasm of injured vessels. This would fall under the category of the golden hour. Most people with at least some reasonable attempt at applying pressure and not having to exert themselves probably have at least an hour to safely get to a hospital. Once there isotonic IV fluids normally can maintain blood pressure until transfusion is possible and in the meantime a surgeon can be dealing with the wound.

 

[DrDoc]

A vertical cut to the abdomen is preferred to a horizontal cut, if muscles are also cut. Sewing abdominal muscles cut horizontally back together is like sewing two brooms together. Usually a net is applied to reduce hernia problem post surgery. Don't let the bowels be cut or he's dead in minutes. A tear rather than a slice cut may bleed more, but as said above, debrieding would require more time in surgery and possible leave an ugly scar (which might be good for your story). I love dragons, but I love and like only the good ones.

FWIW

DrDoc

 

[GeorgeK]

A vertical cut to the abdomen is preferred to a horizontal cut, if muscles are also cut. Sewing abdominal muscles cut horizontally back together is like sewing two brooms together. Usually a net is applied to reduce hernia problem post surgery. Don't let the bowels be cut or he's dead in minutes. A tear rather than a slice cut may bleed more, but as said above, debrieding would require more time in surgery and possible leave an ugly scar (which might be good for your story). I love dragons, but I love and like only the good ones.

DrDoc

No. Not really.In a trauma situation or for that matter even in a controlled cross cut of a muscle you don't really go to great lengths to sew the muscle back together mostly because it basically doesn't work that well. Your analogy of sewing broom ends together is nice for a still picture but inaccurate because the muscle fibers are constantly trying to retract away from each other. In order to get enough of a bite to actually pull on those cut ends you have to loop the suture around a bunch of muscle bundles and then putting that on tension to try to reapproximate it to the other cut end risks devascularizing everything that you looped it around. I haven't seen that technique used since probably the 80's. What works better is to tack the muscle to the underlying fascia at multiple points and using the fascial closure to reapproximate the muscle. Fascia has structural integrity. Muscle really doesn't. Mesh, or the, "net," as you put it would only be necessary if the peritoneum has been opened And there is a defect such that it can not be easily closed, or there is a massive disruption in the deep facial layers. Also as of 2011 placing mesh in the face of a perforated viscous would be a contraindication due to the high risk of the mesh itself getting infected. If it's just the superficial layers and portions of the muscle there would be no need for mesh since there would be no actual defect for the intestines to get entrapped in. Cutting the intestines is not a minutes death sentence. it takes people generally 3-5 days to die from a perforated viscus.

 

[FishyBiscuits]

Thanks guys, this is all really helpful!

I haven't heard of having a drain put in - could you give me some more info on that (ie. what it is, what is does, etc.)?

 

[GeorgeK]

Thanks guys, this is all really helpful!

I haven't heard of having a drain put in - could you give me some more info on that (ie. what it is, what is does, etc.)?

There are many types, some (old style) are just the same rubber tubing that phlebotomists use to make a tourniquet. You lay it in the wound, close the tissue over it and have a single external stitch tying it in place. It's better than nothing but not a great way to drain a potential abscess.

The norm is a closed suction drain, some sort of tube (some are semi rigid, some are soft, maybe flat, round all manner of shapes and sizes, for an abdominal wound as you describe probably about the diameter of a number 2 pencil. The part inside the wound is perforated and the external end is attached to something that provides suction. The norm would be low intermittent suction or very low constant suction. The simplest, and cheapest sort of looks like a hand grenade. It has 2 ports. One that you use to attach to the drain and the other has a plug that you open and then plug and as the bulb tries to reinflate it puts suction on the drain. When it's full or every 6 hours whichever is first you open the plug empty it and record the volume, color and consistency of the drainage then plug it back up and repeat. The color of the drainage will start out red (blood) then pink (blood mixed with serum) them pinkish brown as necrotic debris starts to drain and then yellow to clear. Green is bad it means bacterial infection. A normal course would be the drain removed probably day 2-6 depending on the degree of trauma

 

[FishyBiscuits]

Brilliant, thanks so much!

Just something else I've thought of since my original post - how long would it likely take to fully recover from that kind of blood loss? I know he'd be generally lethargic while his iron levels get back to normal, but I'm not completely sure how long that sort of thing would last. Are we talking a week or two, or more like a month or so?

 

[GeorgeK]

Brilliant, thanks so much!

Just something else I've thought of since my original post - how long would it likely take to fully recover from that kind of blood loss? I know he'd be generally lethargic while his iron levels get back to normal, but I'm not completely sure how long that sort of thing would last. Are we talking a week or two, or more like a month or so?

For just walking around, sedentary desk job a few days to a week or so. For walking a few miles each day, a few weeks. Anything more strenuous about 4-6 weeks and that's all assuming no transfusions and no drugs to boost red cell production.