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

Aloysius Ugwu-Olisa Ogbuanya; Nonyelum Benedett Ugwu; Nwanneka Kwento; Edwin Ifeanyi Enyanwuma; Ferdinand Friday Anyigor; Utom Oko

doi:10.5334/aogh.3973

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

Volume 89 (2023): Issue 1

By: Aloysius Ugwu-Olisa Ogbuanya , Nonyelum Benedett Ugwu , Nwanneka Kwento, Edwin Ifeanyi Enyanwuma, Ferdinand Friday Anyigor and Utom Oko

Open Access

|Jan 2023

Figures & Tables

Table 1

Specific causes of abdominal injuries.

SPECIFIC ETIOLOGIC CAUSE	MECHANISM OF INJURIES
	GUNSHOT	STAB	ASSAULT	OTHERS	TOTAL (%)
Armed Robbery	68	21	2	0	91 (22.9)
Communal clashes	39	21	4	2	66 (16.6)
Political thuggery	30	14	8	2	54 (13.6)
Cult activities	24	15	6	2	47 (11.8)
Farmer-Herder clashes	28	13	1	1	43 (10.8)
Kidnapping/Banditry	39	2	0	0	41 (10.3)
Law enforcement Agency	20	0	0	0	20 (6.0)
Domestic violence	0	4	16	2	22 (5.0)
Public fights	0	5	4	3	12 (3.0)
Rape	0	0	0	2	2 (0.5)
Total	248 (62.3)	95 (23.9)	41 (10.3)	14 (3.5)	398 (100.0)

Table 2

Annual trend of abdominal injuries.

YEAR	MECHANISM OF INJURIES
	GUNSHOT	STAB	ASSAULT	OTHERS	TOTAL (%)
2013	12	7	4	1	24 (6.0)
2014	13	7	3	2	25 (6.3)
2015	15	8	4	1	28 (7.0)
2016	26	10	5	1	42 (10.6)
2017	35	12	5	3	55 (13.8)
2018	41	13	6	1	61 (15.3)
2019	44	16	6	1	67 (16.8)
2020	62	22	8	4	96 (24.1)
Total	248 (62.3)	95 (23.9)	41 (10.3)	14 (3.5)	398 (100.0)

Table 3a

Intra-abdominal injury pattern (Isolated and multiple).

ORGAN/VISCERA INVOLVED	FREQUENCY	PERCENT (%)
Isolated injuries
Small intestine	74	20.3
Colon	51	14.0
Spleen	43	11.8
Liver	26	7.1
Retroperitoneal hematoma	14	3.8
Mesentery	11	3.0
Omentum	6	1.6
Stomach	4	1.1
Rectum	3	0.8
Total	232	63.6
Multiple injuries
Small intestine + colon	28	7.7
Spleen + colon + small intestine	20	5.5
Spleen + liver + mesentery	22	6.0
Liver + omentum + mesentery	16	4.4
Colon + retroperitoneal bleed + spleen	14	3.8
Bladder + small intestine	10	2.7
Kidney + colon + spleen	4	1.1
Stomach + diaphragm	4	1.1
Others	15	4.1
Total	133	36.4

Table 3b

Distribution of extra-abdominal injuries.

REGION	TYPE OF INJURY	NUMBER OF PATIENTS (N = 78)	PERCENT (%)
Head and Neck (10)	Extradural Hematoma	2	12.8
	Brain Contusion/Concussion	3
	Cut throat	1
	Vascular injury	3
	Cervical injury	1
Extremity (12)	Open fracture-tibia	1	15.4
	Open fracture-humerus	2
	Open fracture-radio-ulnar	3
	Open fracture-tibio-fibular	1
	Closed fracture-radio-ulnar	1
	Fracture dislocation	2
	Digital amputation	2
Chest (14)	Tension pneumothorax	3	17.9
	Hemothorax +/– rib fracture	4
	Lung contusion with rib fracture	2
	Hemopneumothorax	5
Maxillofacial (8)	Mandibular fracture	2	10.3
	Maxillary avulsion	3
	Ocular injuries	2
	Ear avulsion	1
Urogenital (3)	Penetrating perineal injury	1	3.8
	Urethral injury	1
	Scrotal hematoma	1
Integument (12)	Deep avulsion injury	3	15.4
	Deep laceration	6
	Multiple abrasions	3
Spine (2)	Lumbar vertebral fracture with neurological deficits	2	2.6
Mixed (17)	Chest/extremity/integument	4	21.8
	Chest/Head and Neck/Maxillofacial	6
	Integument/extremity	4
	Chest/Head and Neck	3
Total		78	100.00

Table 4

Postoperative outcomes.

OUTCOME	MECHANISM OF INJURIES
	GUNSHOT (%)	STAB(%)	ASSAULT(%)	OTHERS(%)	χ²	ODD RATIO
	(N = 244)	(N = 84)	(N = 27)	(N = 10)	(P-VALUE)	(95% CI)
Morbidity
Wound infection	48 (19.7)	6 (7.1)	2 (6.7)	1 (12.5)	3.63 (0.014)	8.32 (5.54–34.66)
Peritoneal abscess	12 (4.9)	2 (2.3)	1 (3.3)	0 (0.0)
Anastomotic leak	5 (2.0)	1 (1.2)	1 (3.3)	0 (0.0)
Atelectasis	4 (1.6)	1 (1.2)	0 (0.0)	0 (0.0)
Sepsis	4 (1.6)	0 (0.0)	1 (3.3)	1 (12.5)
Incisional hernia	4 (1.6)	1 (1.2)	1 (3.3)	1 (12.5)
Burst Abdomen	3 (1.2)	0 (0.0)	1 (3.3)	0 (0.0)
Skin excoriation	3 (1.2)	1 (1.2)	0 (0.0)	0 (0.0)
Stoma retraction	1 (0.4)	1 (1.2)	1 (3.3)	0 (0.0)
Total	84 (34.4)	13 (15.5)	8 (29.6)	3 (30.0)
LOHs (days)
0–7	35 (14.4)	16 (19.0)	4 (14.8)	2 (20.0)	8.84 (0.064)	2.16 (0.43–8.44)
8–14	124 (50.8)	42 (50.0)	13 (48.1)	4 (40.0)
>14	85 (34.8)	26 (31.0)	10 (37.0)	4 (40.0)
Total	244 (100.0)	84 (100.0)	27 (100.0)	10 (100.0)
Mortality	35 (15.6)	6 (7.1)	2 (7.4)	1 (10.0)	3.86 (0.034)	7.11 (9.12–42.19)

Table 5

Effects of clinical and perioperative variables on mortality.

PERIOP PARAMETERS	NO OF CASES	NO OF MORTALITY (%)	χ² (P-VALUE)	OR (95% CI of OR)
Mechanism of injury
Gunshot	248	36 (14.5)	4.73 (0.013)	12.42 (3.52–31.92)
Stab	95	6 (6.3)
Others	53	4 (7.5)
Degree of delay (hours)
0–6	97	6 (6.2)	2.51 (0.002)	7.14 (4.73–33.71)
7–24	112	10 (8.9)
>24	189	30 (15.9)
ASA score
III	116	8 (6.9)	8.24 (0.001)	2.63 (2.15–28.55)
IV	201	23 (11.4)
V	48	15 (31.3 9
Method of treatment
OM	365	44 (12.1)	1.42 (0.024)	11.62 (12.94–44.23)
NOM	33	2 (6.1)		11.62 (12.94–44.23)
Status of anesthetist
Trainee	208	24 (11.5)	13.52 (0.048)	6.32 (4.31–36.11)
Consultant	69	7 (10.1)
Nurse	88	13 (14.8)
Age (years)
16–44	249	27 (10.8)	6.93 (0.033)	3.12 (4.55–22.11)
45–64	117	14 (12.0)
>64	32	5 (15.6)
Type of abdominal injury
Blunt	39	3 (7.7)	2.12 (0.041)	1.21 (7.32–31.11)
Penetrating	359	43 (12.0)		1.21 (7.32–31.11)
Intra-abdominal organ involved
Single	232	23 (9.9)	14.33 (0.034)	9.11 (2.04–19.17)
Multiple	133	21 (15.8)		9.11 (2.04–19.17)
Types of operative techniques
Resection +/– stoma	129	20 (15.5)	3.12 (0.006)	2.11 (4.26–56.22)
Splenectomy only	51	4 (7.8)
Bowel resect + splenectomy	34	6 (17.6)
Intestinal repair	32	1 (3.1)
Proximal diversion	22	1(4.5)
Evacuation + hemostasis	15	0 (0.0)
Others	82	12 (14.6)
Duration of operation (minutes)
30–60	48	5 (10.4)	3.18 (0.084)	4.16 (0.41–8.14)
61–90	78	8 (10.3)
91–120	126	16 (12.7)
>120	113	15 (13.3)

[i] No = number; OR = odd ratio; CI = confidence interval; ASA = American Society of Aneasthesiologists; OM = operative management; NOM = Non-operative management; resect = resection.

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DOI: https://doi.org/10.5334/aogh.3973 | Journal eISSN: 2214-9996

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Language: English

Submitted on: Sep 21, 2022

Accepted on: Dec 17, 2022

Published on: Jan 27, 2023

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

gunshot,

© 2023 Aloysius Ugwu-Olisa Ogbuanya, Nonyelum Benedett Ugwu, Nwanneka Kwento, Edwin Ifeanyi Enyanwuma, Ferdinand Friday Anyigor, Utom Oko, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 89 (2023): Issue 1