Hello Everyone,
I’m rereading a book about personal stories from the Marines who fought on Iwo Jima. One thing that is mentioned quite often is the expectation that when one of the Marines sees another gut shot, he is pretty much a goner. They seem to have little or no hope for any of their fellow soldiers shot in the gut. What makes this type of wound so fatal say compared to a chest wound?
The bullet to the gut releases the enzymes and bacteria contained in the gut into the abdomen. This leads to horrible infections, and repairing the gut surgically requires complex and advanced techniques to remove all of the damaged pieces of gut and carefully leak-test the remaining. (I’ve read that general surgeons do things like inject CO2 through a tube into the gut and put sections of intestine into a saline filled bowl and look for bubbles)
Anyways, in 1944, I guess the success rate for the surgeons wasn’t as high. I suspect it’s an exaggeration and that a significant fraction of Marines did survive getting shot in the gut - a quick check of wikipedia says the American forces had an overwhelming advantage, so hospital ships with operating rooms should have been stationed nearby.
**Habeed **got it in one. The problem is sepsis - dirty bacteria and, well, *crap *going where they’re not supposed to, causing a huge number of individual sites of infection which is likely to lead to systemic organ failure. Too many to clean up, too much for the immune system to handle. Even if you somehow get to the wound in time, stop the bleeding and “short out” that bit of intestine that has been pierced, the damage is done. Even in a modern day hospital, treating septic shock is pretty much a flip of a coin. On a shitty beach in the middle of nowhere ? He’s dead, Jim.
If the stomach itself is pierced it gets worse, as you’ve now got a hugely acidic stream of gunk burning your everywhere. A single, tiny perforated ulcer is already bloody enough, I shudder to imagine a double one made in 7.62.
Your digestive system is designed to dissolve meat. The rest of your body is made out of meat. So when the barrier separating your digestive system from the rest of your body is broken, your digestive system starts treating your internal organs like they’re cheeseburgers.
I don’t understand this technical jibber-jabber. Can you explain it in layman terms?
Hole in guts is bad.
Mmmmm cheeseburger
You want the Reader’s Digest version?
Bravo Sir. Well played. Especially for 2 AM.
Here are the stats:
20% of wounds are abdominal, and half of those are more or less immediately lethal.
Of the half that aren’t immediately lethal, the mortality rate in the Civil War was 87%, in WWI it was was 53%, in WWII about 21%, in Korea about 12%, and even lower in Vietnam- around 4.5% I’m guessing that post-Vietnam the rate is even lower, but I haven’t found any cites for that yet.
The abdomen is rich in large blood vessels. If one gets ruptured, your squad medic can’t do much to keep you from bleeding to death. You need surgery immediately but probably won’t get it.
Other posters mentioned the risks of bacterial infection and digestive leakage, which are indeed huge problems, but these are not as urgent as severe internal bleeding.
Before antibiotics, appendicitis was nearly always fatal when the appendix burst and spilled bacteria into the gut. A gut shot is like that, with even more damage.
Wow. I’m glad to see my response was accurate, even though I didn’t look up the references. I knew that by Iwo Jima, penicillin was available in quantity (a documentary I saw said it was rushed to be ready in quantity for the Normandy invasion), so it was possible to treat some of the sepsis. I’m uncertain how experienced the doctors of 1945 were with getting the most benefit from penicillin, but they had it available and would have used it.
I knew the large arteries that feed the legs (femoral, etc) physically run through the abdomen (it’s the same pipe, they name it something else), so if the projectile breaks that artery, that would explain why the wound would be immediately lethal.
Actually, it’s worse. Since the abdominal aorta and the 2 iliac branches have to be the same size (slightly larger, actually) as the femoral artery, and we know that one has enough blood flow that a person will die if it is cut, it’s fatal if you’re shot in the center of the abdomen or in the center lower left and right quadrants.
Anyways, a medic can save you from a ruptured femoral artery by a tourniquet and/or stuffing the hole with gauze under enough pressure to stop the leak. There’s no way for a medic to find the ruptured abdominal aorta inside the abdominal cavity (it probably will retract so you can’t reach it from the bullet hole, you would have to surgically open up the abdomen and probably move bowel out of the way to find it) before the patient loses enough blood volume to be unrecoverable.
Come to think of it, even if you could get to the artery and hemostat it off, you can’t live without your gut, and cutting blood flow to it is not something you could survive for long. You would have to close the hole, which might be hard to do if it has been traumatically ruptured and the artery is damaged - it might require a graft from somewhere else to close it.
Anyways, that’s probably an hour or more in the operating room to do all that, and you’re in the field, and you have 5 minutes before the patient is brain dead.
Hitting those vessels would be the worst case. However don’t forget there are also numerous medium-sized arteries throughout the abdomen owing to the large circulatory demands of the liver, intestines, kidney, pancreas, stomach, etc. Pretty much anywhere you get wounded in the abdomen, you’re likely to suffer a slow, heavy bleed that the squad medic is not qualified to hunt down and tie off.
Interesting trivia note. Hypochondria nowadays means the mistaken belief that you are ill when you’re not. But the original meaning of hypochondria was the region of your body that contained your liver, spleen, and gall bladder. If you want to be formally correct and distinguish between the two, the belief is hypochondriasis and the area is the hypochondrium.
The crossover arose from the ancient belief that the liver was the seat of emotions. So a person experiencing an emotional condition (like an unfounded fear of being ill) was suffering from a hypochondriac condition.
Relevant clip from the movie Three Kings: Gunshot wound scene
I certainly wouldn’t say that being shot in the gut is MORE lethal than being shot in the chest, but both are very likely to be lethal. When you hunt for deer, you want to shoot through the chest, as hitting the heart or lungs will usually very quickly put the deer down, as well as kill it very quickly. The result is lethal and fast, and humane, and also allows for quick recovery of the animal. Gut-shooting a deer is to be avoided. While eventually lethal, the deer can run for quite a long distance and time while the nastiness goes on in his abdomen. A gut-shot deer will often “get away”, only to die slowly many hundreds of yards away. And if you are able to track the deer, field dressing is a horrible, smelly, messy process.
In terms of war, shooting enemies in the gut means they will occupy much more time and effort on the part of their comrades, who will naturally want to extricate and treat the injured soldier. Wounding enemies is preferable to killing them, in many respects.
I am Joe’s Ticket to the Great Beyond?
Minor nitpick: If we’re talking about WWII Pacific theatre, you’re looking at either 6.5mm or 7.7mm holes in your patients.