Abdominal Injuries from Civilian Conflicts: An Emerging Global Health Challenge in Rural Southeast Nigeria

Background: In recent time, incidence of abdominal injuries continues to increase steadily in most major regions of West Africa due to emergence of various religious, social and political conflicts. Indeed, violence and social conflicts constitute major global public health challenges that commonly lead to injuries and long-term physical and mental health problems. In our setting, increasing cases of abdominal trauma resulting from civilian violence led to additional workload in the general surgery unit and the audit of our experiences is presented in this paper.Objective: To analyze the etiological spectrum, trend and management outcome of abdominal injuries from civilian violence in our setting. Methods: This was a multicenter prospective study of adult patients with abdominal injuries from civilian conflicts managed at three selected district hospitals in Southeast Nigeria between January 2013 to December 2020.Findings: Of 398 patients evaluated, 359 (90.2%) sustained penetrating while 39 (9.8%) had blunt abdominal injuries. Gunshot was the most common mechanism, accounting for 248 (62.3%) cases, followed by stab wound (95, 23.9%). Armed robbery attack (68, 27.4%) was the main source of gunshot wounds. Overall, annual rates showed a four-fold rise over an eight-year period from 24 cases (6.0%) in 2013 to 96 (24.1%) in 2020. Majority (365, 91.7%) had operative management (OM); the rest (33, 8.3%) were treated non-operatively. Morbidity and mortality rates for operative cases were 29.6% and 12.1% respectively. The main factors associated with increased mortality rates were delayed presentation (p = 0.002), bowel resection (p = 0.006), gunshot wounds (p = 0.013), advanced age (p = 0.033), multiple visceral injury (p = 0.034) and ASA score > III (p = 0.001).Conclusion: Abdominal trauma from civilian violence is on the steady rise in our setting. The main etiologic factors are armed-robbery, communal clashes, political thuggery and cultism perpetrated predominantly through gunshots and stab wounds. Advancing age, gunshot wounds, delayed presentation, bowel resection and multiple injuries were associated with increased mortality.