Polite Dissent

Punisher #28 “The Slavers, part 4”
Garth Ennis, writer
Leandro Fernandez, penciler

I’ve had a request to look at the Punisher’s impromptu surgery in Punisher #28 (current series). The images are rather graphic — and since I don’t want to scare any small children or Congressmen — you’ll have to click on the thumbnails at the bottom of the post to see the full pages (or buy the comics or trade).

Now let’s talk about the Punisher’s surgical skills:

1. Is this even anatomically possible?
In the average adult male, the small intestine is 20 feet (6 m) long. That’s certainly long enough to loop around a few branches like in the picture.
On the other hand, the small intestine is not just lying loose in the abdomen. It’s tethered to a membrane known as the mesentery. This is a very important anatomical structure because it carries the blood supply and nerves of the intestine. To get one large loop of bowel like the one shown in the panel, the Punisher would have to cut away nearly all the mesentery. It’s certainly possible, it would just be very messy and time consuming — plus likely fatal to the bowel.

2. What about infection?
There is a very high risk of infection. First, the abdominal cavity is open to the world. In medical parlance, this is called a “bad idea.” It leaves a normally sterile environment wide open for invading germs. Second, as mentioned above, the Punisher cut away the blood supply to the intestine. A dying or dead bowel is very susceptible to infection. Finally, given its “artistic arrangement,” the bowel is likely to get some wood splinters or bark chips embedded in it. Plant matter carries a high rate of infection because of the wide variety of bacteria, fungi, and other organisms that inhabit it.

3. Is this survivable?
Barely, at best. Our victim requires emergency surgery quickly. Without a blood supply, the bowel is dying. In the best case scenario, the patient will lose most of his small intestine, need massive amounts of powerful antibiotics, and require an extended stay in the hospital. A far more likely scenario has him dying long before he reaches the hospital, let alone the operating room.

Final thoughts:
It’s nice to see that the Punisher wore gloves (or at least a glove) when operating, but I’m sure it was more to protect himself from infection rather than reduce his patient’s risk of infection.
I’m not sure what drug was in that small syringe, but it must have been powerful for our victim to endure that surgery without waking up.
That is simply a great Tim Bradstreet cover.