EVALUATION OF ABDOMINAL BULLET INJURIES IN BASRAH GENERAL HOSPITAL (A PROSPECTIVE STUDY)

Abstract

EVALUATION OF ABDOMINAL BULLET INJURIES IN BASRAH GENERAL HOSPITAL (A PROSPECTIVE STUDY) Jabar K Jassim#, Mazin H Al-Hawaz@, Mazin A Abdellah& #FICMS Candidate, Basrah General Hospital, @Professor of Surgery, Head of Dept.of Surgery, College of Medicine, Basrah. &CABS, Basrah General Hospital, Basrah, IRAQ. Abstract The incidence of civilian abdominal gunshot wounds is on the increase in many cities, attributed to the increasing rate of unemployment, high rate of corruption in the polity, and political violence. Gunshot wounds of the abdomen are associated with 90% or greater incidence of intra abdominal injury, prompting many trauma centers to routinely explore these patients via laparotomy. The aim of this prospective study was to evaluate the pattern of injuries, treatment, and outcome of patient with abdominal gunshot wounds in Basra General Hospital. This is a prospective study of patients with abdominal gunshot wounds admitted to Basra General Hospital, Department of Surgery, between April 2003 to October 2005. One hundred and sixteen patients were included in this study. Data recorded on database. Patient's characteristics, injury to arrival time, type of weapon, single or multiple gunshot wounds, surgical intervention time, clear urine or macroscopically haematuria, preoperative and postoperative blood transfused, operative finding, and postoperative complications and mortality. The indications for emergency laparotomy after vigorous resuscitation were shock, peritonitis, evisceration, leakage of intestinal content through wound, haematemesis, proctorrehagia, and macroscopical haematuria with entrance wound. The study included 116 patients, Male:Female ratio was 4:1 and 44.8% of patients ranged in age from 20-29 years. The common weapon used was gun in 88.8%patients. Three (2.6%) patients sustained superficial wounds of the abdomen; they were managed by local wound care. Laparotomy was undertaken in 113 (97.4%) patients who presented with acute abdomen. The commonest injured organ was the small intestine (26%), colon (18.8%), liver (11.7%), kidneys (9%) and stomach (6.7%).The mortality rate was 10.6%. shock was the cause of death in 9 patients. It is concluded that Bullet injury is a serious injury which need careful attention by surgeon .Mandatory exploration is the standard method for managing patient with gunshot wounds to the abdomen and back;. Most of the deaths in this study are due to haemorrhagic shock. The unavailability of blood in our hospital blood bank and the delay in bringing blood from the central blood bank add adverse effect on the outcome of patient.