Pattern and Outcome of abdominal gunshot wounds in El-Fashir Teaching Hospital

Abstract

Background:Abdominal gunshot wounds (GSWs) are important cause of morbidity and mortality
worldwide in both military and civilian settings. They are commonly encountered in the western states of
Sudan where the civil war and tribal conflicts are prevalent.
Objectives: To describe the pattern of presentation and outcome of abdominal gunshot wounds and to
assess the factors that predict morbidity and mortality at El-Fsahir Teaching Hospital, Northern Darfur.
Patients and Methods: It is a retrospective, analytical, hospital- based study. Data were collected
by retrospective review of hospital records of patients with abdominal gunshot wounds who presented
between January 2006 and December 2012.
Results: A total number of seventy four patients were included. Male to female ratio was 5:1. The majority
of patients 67 (90%) were below the age of 40 years. More than half of the patients 39 (52.7%) had a
delayed presentation to the hospital (after eight hours since the time of injury). About one-fourth of patients
18 (24.3%) were shocked at the initial presentation. Surgical exploration was performed in all patients. The
most commonly injured organs were: the small intestine 43 (57.1%), the colon 33(44.6%), the stomach and
the liver 9(12.2% each). Negative exploration was encountered in six (8.1%) patients. Associated extraabdominal
injuries were found in 24 (33.1%) patients. They were mainly in the extremities 17 (23%), the
chest seven (9.5%) and the pelvis four (5.4%).The overall morbidity was 44.6% (n=33). They were mainly:
surgical site infections (SSI)followed by septicemia. Colonic injuries are associated with a higher risk of
SSI and septicemia. The mortality rate was 21.6% (n=15). The commonest causes of death were septicemia
and hypovolemic shock.
Conclusion: There was a high incidence of morbidity (44.6%) and mortality (21.6%) among patients with
abdominal gunshot wounds in El-Fashir Hospital in comparison to the literature. This can be explained by
various reasons including: the lack of appropriate pre-hospital trauma management; the delayed presentation
to the hospital (as a result of insufficient ambulance services and lack of adequate security) and the shortage
of well-trained staff. Presence of colonic injuries, increasing number of injured intra-abdominal organs and
associated extra-abdominal injuries are predictors of poor outcome in patients with abdominal gunshot
wounds in El-Fashir hospital.