Abdominal trauma comprises one-third of the whole number of trauma in the emergency setting [9]. It is caused by penetrating (open) or blunt trauma (closed). These two types vary from area to area with more penetrating injuries in civilization regions and more blunt injuries in rural areas [10]. Abdominal trauma in the present study had a prevalence of 6.6% with more penetrating (90%) than blunt injuries. Around 20% of the patients die due to severe bleeding or septicemia.
The prevalence of abdominal trauma in the Middle East ranged from 15–82% [11]. The prevalence rate of the abdominal trauma from the total cases of trauma admitted to the emergency unit in the present study (6.6%) was less than the study by Ibrahim et al. (14.1%) [12]. This may be attributed to that considerable cases were excluded from the current study Fig. 1.
In literature, abdominal trauma occurs mostly in the second and third decades of life [1][4][13][14]. This study shows that the highest prevalence of trauma occurred in patients less than 30 years with a mean age of 26.32 years, which was nearly similar to other studies [1][4][8][15]. This points out that this group is the active group in society. However, in the current study, the mean age was lower than the study by Bordoni et al. who reported that the median age was 34 years [2]. This may be attributed to the difference in the number and type of studied sample between the two studies, Bordoni et al. studied 1888 deaths from abdominal injuries. Besides, Gönültaş et al. reported that the mean age was 36.08 ± 16.1 years which was higher than the mean age of the current study [16].
This study has also shown that the males were more injured than females with a ratio of male to female 9.6 to 1 which agrees with other studies [3][11][16][17][18][12]. This may be attributed to that males are more prevalent in outdoor activities, more found in assaults injuries, and participating in certain jobs like a soldier.
The penetrating trauma is the predominant type in this study, which was similar to other studies [2][8][19]. While in contrast with other studies [4][11][16][18][20] were blunt trauma is the major cause of abdominal trauma. This difference of course is the result of the differences in geographical distribution and socio-cultural behaviors. Moreover, the distribution among the causes of abdominal injuries might change from time to time depending on the events that might occur in certain geographical locations.
The type of trauma (penetrating or blunt) and cause of injury (missile, sharp objects, RTA, FFH, etc.) might determine the injured intra-abdominal organs. Solid organs (liver and spleen) are more injured in blunt injury. While penetrating trauma could injure more the hollow organs (small and large bowel). However, the injured organ in penetrating trauma depends on the pathway of the penetrating objects and the cavitation effect of the high velocity penetrating object like a bullet. Our study shows that the frequency of organs injury in penetrating trauma was similar to the result of a previous study in penetrating abdominal trauma in Ramadi City, Iraq [21]. The small bowel was the commonest injured organ in the current study. This finding was in contrast with Smith et al. study who found that solid organs are more injured than hollow ones [18]. Besides, Mehta et al. reported that the spleen was injured in 53% of cases [17].
Abdominal trauma is found in around 20 percent of subjects admitted to the emergency units and carries a high fatality rate of about 20 percent. Early admission, accurate diagnosis, and management in trauma centers are important factors in reducing the mortality rate from abdominal trauma [22][23]. The prevalence of death due to abdominal trauma from many countries ranged from 0%-19.4% [3][4][8][13][15][16][17][12][24][25][26][27][28]. The fatality rate of 20.3% in the current study was higher than the reported in the above-mentioned studies. This may be attributed to the that the penetrating trauma in our study was more than the blunt injury (penetrating trauma carries high mortality in comparison with blunt trauma) as well as the exclusion cases of patients with the conservative treatment and negative laparotomy of the patients with abdominal trauma. Ntundu et al. reported that the negative predictive value on the fatality rate in patients with abdominal trauma was extra-abdominal associated trauma to the pelvis or head, hospitalization period ≥ 7 days, systolic blood pressure less than 90 mm Hg, anemia, the severity of the injury, and time > 6 hours elapsed from trauma to admission [27]. The present study showed that younger patients, the shorter time elapsed before admission, low mean blood pressure at the time of the presentation, and long hospital stay were a negative impact on the death rate. From the above, we can conclude that the early presentation, hemodynamically stable patients, use of imaging techniques (ultrasound, and CT scans), and the use of laparoscopy rather than open laparotomy whenever it is possible are responsible for early discharge with better outcomes.
Postoperative wound infection was the most common complication (14,9%) in our study. However, most of them were simple and managed conservatively. A similar finding was reported by Mehta et al. [17], but much lower than what was reported by Chalya et al. (27.1%) [4]. The possible causes in these patients were dirty wounds, necrotic tissue, distorted traumas, and delayed presentation in some cases [17]. Laparoscopic management of the abdominal trauma carries less postoperative wound infection than open laparotomy. The study by Lim et al. reported 5 cases of postoperative wound infection in open laparotomy and nil in the laparoscopic treatment of patients with abdominal trauma [24]. The relatively high rate of postoperative wound infection in the current study and the studies by Mehta et al. and Chalya et al. may be attributed to the management by open laparotomy rather than using laparoscopy.
Owing to the lack of experience in diagnostic laparoscopy in blunt abdominal trauma, we didn't use this tool in the current study, and this was one of the limitations of the study. Small sample size, as well as no assessment of the severity of trauma in the study, were considered other limitations.