Document Type: Original Article

Authors

1 Department of Surgery, Ekiti State University, Ado-Ekiti, Nigeria

2 Department of Surgery, Obafemi Awolowo University Teaching Hospital, Obafemi Awolowo University, Ile-Ife, Nigeria

3 Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria

Abstract

Objective: There has been a worldwide rise in the prevalence of penetrating abdominal injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating abdominal injuries and the treatment outcome in our center.
Methods: This descriptive study of adult patients managed for PAI was conducted at the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti from January 2015 to December 2018. Data were prospectively collected and analyzed by using descriptive statistics from Statistical Package for Social Sciences (SPSS) version 20.0.
Results: There were 96 patients managed for abdominal injuries during the study period. Forty-six (47.9%) of them had PAI, while 50 (52.1%) others sustained blunt trauma. Patients ages ranged from 17-72 years (mean = 34.2±10.8 years; median = 34 years). Majority, 42 (91.3%), were males, while 4 (8.7%) were females (M: F=11:1). The most afflicted age group was in the 4th decade. Majority of the injuries were due to gunshot (60.9%) followed by stab (26.1%), unsafe abortion (6.5%), road traffic injury (4.3%) and fall (2.2%). Gastrointestinal injuries were the most common with small bowel perforations predominating. Solid organ injuries were only seen in 3 (7.9%) patients. Eight (17.4%) had associated extra-abdominal injuries. Thirty-eight (82.6%) patients required exploratory laparotomy, while 8 (17.4%) were managed non-operatively. The negative laparotomy rate was 2.6%. Seven (15.2%) patients developed complications which were mostly wound infection (10.8%). The duration of hospital stay was 1-58 days (mean 12.7±10.5). Three patients (6.5%) with gunshot injuries died.
Conclusion: Gunshot wounds were the major variant of PAI, and the highest cause of mortality from it. Gut injuries were most common, and exploratory laparotomy remains the main-stay of treatment, while non-operative management is practicable in carefully selected cases.

Keywords

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1. Aldemir M, Tacyildiz I, Girgin S. Predicting factors for mortality in the penetrating abdominal trauma. Acta Chir Belg 2004; 104(4): 429-34.
2. Mohammed AZ, Edino ST, Ochicha O, Umar AB. Epidemiology of gunshot injuries in Kano, Nigeria. Niger J Surg Res 2005; 7(3-4): 296-9. doi: 10.4314/njsr.v7i3.12301.
3. Udosen AM, Etiuma AU, Ugare GA, Bassey OO. Gunshot injuries in Calabar, Nigeria: an indication of increasing societal violence and police brutality. Afr Health Sci 2006;6(3): 170-2. doi: 10.5555/afhs.2006.6.3.170.
4. Etonyeaku AC, Ogundipe KO, Omotola CA, Ishola OJ, Olasehinde O, Obonna GC. Spectrum of Gunshot Injuries in Civilian Practice at a Tertiary Hospital in a Semi-rural Community in Nigeria. East Cent Afr J Surg 2014; 19(1):83-9.

5. Edino ST. Pattern of abdominal injuries in Aminu Kano Teaching Hospital, Kano. Niger Postgrad Med J 2003; 10(1):
56-9.
6. Ohene-Yeboah M, Dakubo JC, Boakye F, Naeeder SB. Penetrating abdominal injuries in adults seen at two teaching hospitals in ghana. Ghana Med J 2010; 44(3): 103-8.
7. Navsaria PH, Berli JU, Edu S, Nicol AJ. Non-operative management of abdominal stab wounds--an analysis of 186
patients. S Afr J Surg 2007; 45(4): 128-30, 32.
8. Tsikitis V, Biffl WL, Majercik S, Harrington DT, Cioffi WG. Selective clinical management of anterior abdominal stab
wounds. Am J Surg 2004; 188(6): 807-12. doi: 10.1016/j.amjsurg.2004.08.046.
9. Olaogun JG, Akute OO, Etonyeaku AC, Ige JT, Ajibola DB, Afolayan JM, et al. Abdominal trauma in a semi-urban
tertiary health institution. J Emerg Pract Trauma 2018;4(2): 67-72. doi: 10.15171/jept.2018.07.
10. Asuquo ME, Umoh MS, Nwagbara V, Ugare G, Agbor C, Japhet E. Penetrating Abdominal Trauma: Experience in A
Teaching Hospital, Calabar, Southern Nigeria. International Journal of Clinical Medicine 2012; 3(5): 426-30. doi:
10.4236/ijcm.2012.35079.
11. Omer MY, Hamza AA, Musa MT. Penetrating Abdominal Injuries: Pattern and Outcome of Management in Khartoum. International Journal of Clinical Medicine 2014;5(1): 18-22. doi: 10.4236/ijcm.2014.51004.
12. Dogo D, Yawe T, Hassan AW, Tahir B. Pattern of abdominal trauma in North Eastern Nigeria. Niger J Surg Res 2000;
2(2): 48-51. doi: 10.4314/njsr.v2i2.12184.
13. Monzon-Torres BI, Ortega-Gonzalez M. Penetrating abdominal trauma. S Afr J Surg 2004; 42(1): 11-3.

14. Akhiwu WO, Igbe AP. Fatal gunshot injuries in Benin City, Nigeria. Med Sci Law 2013; 53(4): 199-202. doi:
10.1177/0025802413483718.
15. Osime C, Kpolugbo J. Pattern and outcome of penetrating injuries in Irrua, a sub-urban community in Nigeria. Afr J
Trauma 2004; 2: 40-2.
16. Fawole AA, Aboyeji AP. Complications from unsafe abortion: presentations at Ilorin, Nigeria. Niger J Med 2002;
11(2): 77-80.
17. Tillu N, Rathod C, Kumar M, Kumar V. A study to assess the 30 days outcome of penetrating injuries to the
abdomen. Int Surg J 2017; 4(1): 64-74. doi: 10.18203/2349-2902.isj20164053.
18. Ayoade BA, Salami BA, Tade AO, Musa AA, Olawoye OA. Abdominal Injuries in Olabisi Onabanjo University
Teaching Hospital Sagamu, Nigeria: Pattern and Outcome. Niger J Orthop Trauma 2006; 5(2): 45-9.
19. Shaftan GW. Indications for operation in abdominal trauma. Am J Surg 1960; 99: 657-64. doi: 10.1016/0002-
9610(60)90010-6.
20. Van Brussel M, Van Hee R. Abdominal stab wounds: a fiveyear patient review. Eur J Emerg Med 2001; 8(2): 83-8.
21. Olaogun JG, Popoola SO, Olatunya OS, Oluwadiya KS. Where there is no specialist: surgical care in a secondary
health facility in a developing country. Egypt J Surg 2014; 33(4): 223-7. doi: 10.4103/1110-1121.147596.
22. Lone GN, Peer GQ, Warn KA, Bhat AM, Warn NA, Bhat MA. An experience with abdominal trauma in adults in
Kashmir. JK Pract 2001; 8(4): 225-30.
23. Feliciano DV, Burch JM, Spjut-Patrinely V, Mattox KL, Jordan GL Jr. Abdominal gunshot wounds. An urban
trauma center’s experience with 300 consecutive patients. Ann Surg 1988; 208(3): 362-70. doi: 10.1097/00000658-
198809000-00014.