Abdominal injuries in communal crises: The Jos experience

Abstract

Background:Abdominal injuries contribute significantly to battlefield trauma morbidity and mortality. This study sought to determine the incidence, demographics, clinical features, spectrum, severity, management, and outcome of abdominal trauma during a civilian conflict.Materials and Methods:A prospective analysis of patients treated for abdominal trauma during the Jos civil crises between December 2010 and May 2012 at the Jos University Teaching Hospital.Results:A total of 109 victims of communal conflicts with abdominal injuries were managed during the study period with 89 (81.7%) males and 20 (18.3%) females representing about 12.2% of the total 897 combat related injuries. The peak age incidence was between 21 and 40 years (range: 3–71 years). The most frequently injured intra-abdominal organs were the small intestine 69 (63.3%), colon 48 (44%), and liver 41 (37.6%). Forty-four (40.4%) patients had extra-abdominal injuries involving the chest in 17 (15.6%), musculoskeletal 12 (11%), and the head in 9 (8.3%). The most prevalent weapon injuries were gunshot 76 (69.7%), explosives 12 (11%), stab injuries 11 (10.1%), and blunt abdominal trauma 10 (9.2%). The injury severity score varied from 8 to 52 (mean: 20.8) with a fatality rate of 11 (10.1%) and morbidity rate of 29 (26.6%). Presence of irreversible shock, 3 or more injured intra-abdominal organs, severe head injuries, and delayed presentation were the main factors associated with mortality.Conclusion:Abdominal trauma is major life-threatening injuries during conflicts. Substantial mortality occurred with loss of nearly one in every 10 hospitalized victims despite aggressive emergency room resuscitation. The resources expenditure, propensity for death and expediency of timing reinforce the need for early access to the wounded in a concerted trauma care systems.

Penetrating Abdominal Trauma in Children: A Tertiary Hospital Experience in a Developing Country

“…However, Ameh et al reported fall onto sharp objects within and around the home as the most common cause of penetrating abdominal injury in children [3]. In areas of terrorist attacks and civil war, incidence of abdominal gunshot injuries is high [17,18]. Penetrating abdominal injuries in children that occur at home usually result from accidental falls [19].…”

Conservative management of penetrating abdominal trauma (stab wound)

“…Recommendation for the management of the remaining patients (40%) who are mostly asymptomatic with minimal or equivocal abdominal signs at the initial clinical examination is still controversial. 8,9,1…”

Abdominal Trauma Management: About 62 Cases at the Department of General Surgery of Hôpital Sominé DOLO de Mopti, Mali

“…We did not perform CT scans due to the unavailability of the device during the study period. Taking into account the anatomical relationships of the abdominal cavity on the one hand, and the violence of the trauma on the other hand, extra-abdominal lesions associated with AT are very common [2][9]. Besides splenic lesions which represented 17 cases (27.42%), we recorded one case of kidney injury (1.61%) of cases in our study.…”