This man was employed as a General Duty Orderly (which included stretcher bearing -) in this unit. While carrying out these duties, he had several attacks of abdominal pain accompanied by vomiting and dilitation of the stomach. these attacks generally subsided in a few hours. At 6am on 5.8.16, he was seized with violent abdominal pain. He was immediately admitted to hospital, and found to be suffering from acute intestinal obstruction.

Operation 10:30 am - 5.8.16 - Laparotomy was performed. About 15 feet of small intestine were found to be strangulated in a paraduodenal fossa. This strangulated intestine was freed, patient improved for two days, when peritonitis ensued.

Operation 7:30pm - 7.8.16 - The wound was reopened. Thrombosis had ensued in the meseuteric vessels. About six feet of gangrene gut was excised, and Paul's tube inserted into the cut ends. The patient never rallied from the operation, and died at 9:50pm 7.8.16.

Autopsy - A large paraduodenal fossa existed. The rest of the small intestine showed many patches of gangrene. Extensive leakage had taken place, and peritonitis was well established.

Conclusion - Cause of death was peritonitis following gangrene of the small intestine the result of thrombosis of the mese?? vessels caused by strangulation in a paraduodenal fossa.

In my opinion, although the fossa was of long ?? the entry of the intestines into the sac, and the subsequent ?? strangulation was caused by increased intra-abdominal pressure present as the result of carrying out his duties as a General Duty Orderly while on Active Service.

Captain R.A.M.C., T. C. Mackenzie,
Surgical Specialist,
No.14 General Hospital, Wimereux, 14.8.16