Management of penetrating abdominal trauma

Management of penetrating abdominal trauma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Management of penetrating abdominal trauma Bassam Nayef Maanieh, Anas Muhammad Murad, Abdulrahman Ahmad Hammadieh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6719526/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Penetrating abdominal trauma is a common surgical emergency requiring prompt intervention to reduce morbidity and mortality. This study aimed to evaluate the patterns of intra-abdominal injuries resulting from penetrating trauma in a teaching hospital setting. Materials and Methods: We conducted a retrospective study including 122 patients treated at Al-Mouwasat University Hospital between 2022 and 2024. Clinical and demographic data were collected from patient files using a structured paper-based questionnaire. Data were analyzed using descriptive statistics via SPSS software. Results: The majority of patients were male (87%), and the most affected age group was 21–30 years. Surgical intervention was performed within 24 hours in 93% of cases, and 85% of patients were hemodynamically stable at admission. The most common cause of injury was gunshot wounds (33%), followed by blast injuries (26%). The small intestine was the most frequently injured organ (34.4%), followed by the spleen (32.7%). Postoperative complications included bleeding in 8.2%, infection in 14.7%, and mortality in 6.5% of patients. Conclusion: Early surgical intervention and detailed assessment of injury patterns significantly contribute to better patient outcomes. Our findings partially align with international data, with local variation in injury mechanisms. General Surgery Penetrating injury exploratory laparotomy intestinal trauma AAST score Introduction Penetrating abdominal trauma is a critical emergency frequently encountered in trauma and surgical units, primarily resulting from stab wounds and gunshot injuries. These injuries involve the entry of a sharp or high-velocity object into the peritoneal cavity, often damaging internal organs such as the liver, intestines, spleen, or major blood vessels. The initial assessment and management are guided by the Advanced Trauma Life Support (ATLS) principles, with rapid identification of hemodynamic instability or peritoneal signs being crucial for determining the need for urgent surgical intervention [ 1 ][ 2 ]. While unstable patients typically require immediate exploratory laparotomy, stable patients may undergo selective nonoperative management supported by diagnostic tools like Focused Assessment with Sonography in Trauma (FAST) and contrast-enhanced computed tomography (CT) [ 3 ][ 4 ]. Advances in imaging and clinical algorithms have enabled a more conservative approach in select cases, minimizing unnecessary surgeries and associated morbidity [ 5 ][ 6 ]. This study aims to evaluate the clinical presentation, diagnostic approach, and outcomes of patients with penetrating abdominal trauma, and to assess the effectiveness of different management strategies (operative vs. nonoperative) based on hemodynamic status and mechanism of injury. Methods and materials Study Design and Setting: This study was conducted using a retrospective design in the Emergency Department of the General Surgery Division at Al-Mouwasat University Hospital in Damascus. The study period extended from January 1, 2022, to December 31, 2024. It included patients who presented to the hospital with a history of penetrating abdominal trauma and were managed within the General Surgery Division during the specified period. Inclusion Criteria: Patients who were evaluated and treated in the General Surgery Division and Emergency Department at Al-Mouwasat University Hospital. Patients aged between 10 and 70 years. Exclusion Criteria: Patients with multiple trauma. Patients younger than 10 years or older than 70 years. Patients with major abdominal vascular injuries or injuries to the urinary tract. Data Collection Tool: A paper-based data collection form was used to extract clinical and demographic data from the medical records of the included patients. The form was designed to capture a set of core variables related to the clinical status of the patient and the surgical intervention performed. It began with general demographic data such as age and gender, followed by variables related to the timing of surgical intervention, specifically the time interval (in hours) between injury occurrence and surgical intervention. Initial hemodynamic status at presentation (stable/unstable) was recorded, in addition to the cause of injury (e.g., stab wound, gunshot, or other sharp object). The form also included classification of the trauma pattern based on the entry site and the number of wounds, with accurate documentation of the injured organs. For clinical analysis purposes, the form incorporated both qualitative and quantitative classifications of injury severity, with grading of organ-specific injuries according to standard surgical scales (e.g., AAST classification, where available in the records). Lastly, complications occurring during the treatment period were documented, including hemorrhage, infection, intestinal leakage, the need for reoperation, or other clinically relevant adverse outcomes. Statistical Analysis: Only descriptive statistical analysis was performed. Categorical variables were summarized using frequencies and percentages, while continuous variables (e.g., age, time interval to surgery) were expressed as means and standard deviations. Data were processed using either Microsoft Excel or SPSS software, as appropriate. Results This study included a sample of 122 patients who suffered from penetrating abdominal trauma during the specified study period. Demographic, clinical, and surgical data were analyzed based on several key variables. Age and Gender Distribution: The results showed that the majority of patients were male, with 106 male patients (87%) compared to only 16 female patients (13%), indicating a clear predominance of penetrating abdominal injuries among males. Regarding age distribution, patients were categorized into six age groups with 10-year intervals. The most represented group was the 21–30 years’ age group, which included 54 patients (44.26%). This was followed by the 31–40 and 41–50 years’ groups, each with 16 patients (13.11%). The 51–60 age group included 14 patients (11.48%), while the youngest group (10–20 years) included 12 patients (9.84%). The oldest group (61–70 years) consisted of 10 patients (8.20%). This distribution reflects that the majority of injuries occurred in economically and socially active individuals. Time Interval Between Injury and Surgery: Analysis showed that 104 patients (93%) underwent surgical intervention within less than 24 hours from the time of injury, while only 8 patients (7%) received surgery after more than 24 hours. This demonstrates a relatively rapid response in managing penetrating abdominal injuries, which often require urgent surgical intervention to avoid complications. Hemodynamic Stability Upon Admission: In terms of hemodynamic status at the time of admission, 104 patients (85%) were classified as stable, while 18 patients (15%) presented in an unstable condition, indicating the presence of significant intra-abdominal vascular injuries in a considerable proportion of cases. Stability was determined immediately upon arrival at the emergency department, based on vital signs (blood pressure and heart rate), and considering age, gender, and weight. Cause of Injury: The causes of injury varied among patients. The most common cause was gunshot wounds, accounting for 40 cases (33%). This was followed by blast injuries with 32 cases (26%), and other sharp objects such as knives. These findings reflect the impact of environmental and security conditions on the nature of recorded injuries. Intraoperative Evaluation of Injuries: All patients underwent exploratory laparotomy to identify the type and extent of injury. The small intestine was the most commonly injured organ, involved in 42 cases (34.4%), followed by the spleen in 40 cases (32.7%), and the liver in 15 cases (12.3%). Injury Severity Classification According to AAST: Injury severity was classified using the American Association for the Surgery of Trauma (AAST) grading system. In cases of multiple injuries, the highest severity grade was recorded for analysis: Stomach Injuries: A total of 7 cases were documented. Most were Grade II (4 patients, 57.1%), followed by Grade III (2 patients, 28.6%), and one case was Grade I (14.3%). Small Intestine Injuries: Of the 42 cases, 22 were Grade III (52.3%), 15 were Grade II (35.7%), and 5 were Grade I (13%). Colon Injuries: Out of 12 cases, 6 were Grade III (50%), while both Grade I and Grade II had 3 cases each (25%). Liver Injuries: Among 15 cases, the majority were Grade I (33.3%), followed by Grade II (26.7%), and Grade III (20%). Higher grades (IV and V) were less common. Spleen Injuries: Of 40 cases, 18 were Grade IV (45%), 7 were Grade V (17.5%), 6 were Grade II (15%), 5 were Grade III (12.5%), and 4 were Grade I (10%). Pancreatic Injuries: Out of 6 cases, both Grade III and IV were the most frequent (2 patients each, 33.3%), while Grade I and V each had 1 case (16.7%). No Grade II injuries were observed. Postoperative Complications: Postoperative complications were assessed, including hemorrhage, infection, and mortality: Hemorrhage: Occurred in 10 patients (8.2%). Infection (sepsis): Reported in 18 patients (14.75%). Mortality: 8 patients died, representing 6.56% of the total sample. Discussion This study included 122 patients, selected after the exclusion of 10 cases that did not meet the inclusion criteria. Demographic analysis revealed that the majority were male (87%), while females represented 13% of the cohort. The most affected age group was between 21 and 30 years, reflecting a common epidemiological pattern in traumatic injuries affecting young, active individuals. Regarding the timing of surgical intervention, 93% of patients underwent surgery within less than 24 hours from the time of injury. This indicates efficient emergency surgical response and is associated with improved clinical outcomes. Hemodynamically, 85% of patients were stable upon admission, which allowed for appropriate surgical preparation and evaluation. The leading cause of injury was gunshot wounds, accounting for 33% of cases, followed by explosive injuries at 26%. This pattern reflects the geopolitical and security context in which the study was conducted. In terms of injured organs, the small intestine was the most commonly affected (34.4%), followed by the spleen (32.7%), consistent with mechanisms of penetrating trauma, which typically affect hollow and vascular organs. The American Association for the Surgery of Trauma (AAST) classification was used to grade organ injuries. The main findings were as follows: For gastric injuries, the majority were grade 2 (57.2%). For small bowel injuries, grade 3 was most frequent (52.3%). For colonic injuries, grade 3 predominated (50%). In hepatic injuries, grade 1 was most common (33.3%). For splenic injuries, grade 4 was most frequently observed (45%). In pancreatic injuries, the most common grades were 3 and 4 (33.3% each). Postoperative complications included bleeding in 10 cases (8.2%), surgical site infection in 18 cases (14.7%), and postoperative mortality in 8 cases (6.5%). Comparison with Similar International Studies: The findings of this study are in agreement with several international peer-reviewed studies concerning the epidemiological distribution. Five studies reported that the 21–30-year age group was the most affected by abdominal trauma, with a clear predominance of males (approximately 85–90%) [ 7 – 11 ]. However, there were notable differences in the mechanism of injury. While road traffic accidents were the leading cause in most international reports—such as in the studies by Weinberg et al. [ 7 ] and Ranjan et al. [ 8 ]—explosive injuries and gunshot wounds were more frequent in our cohort, likely reflecting contextual and environmental differences. In terms of injured organs, this study aligns with global literature in identifying the small intestine as the most commonly affected organ in penetrating abdominal trauma, as reported by Traoré et al. [ 9 ] and Naqvi et al. [ 10 ]. The incidence of postoperative hemorrhage in our study was 8.2%, similar to international ranges (6–10%) [ 7 – 11 ]. However, the rate of surgical site infections (14.7%) was higher than that observed in comparable studies, such as Pradhan et al. [ 11 ], which reported a rate of 9.5%. This discrepancy may be attributed to differences in surgical sterility, resource availability, or postoperative care protocols. The mortality rate in our cohort was 6.5%, comparable to those reported by Naqvi (6%) [ 10 ], Ranjan (5%) [ 8 ], Weinberg (7%) [ 7 ], and Traoré (10%) [ 9 ], but higher than in Pradhan’s study (2%) [ 11 ]. These differences could be due to variations in injury severity, patient triage systems, or institutional treatment guidelines. Conclusion This study reviewed 122 cases of penetrating abdominal trauma treated surgically at a tertiary care center. Young adult males aged 21–30 years were the most affected group. Gunshot wounds were the leading cause of injury, followed by explosive trauma. The small intestine was the most frequently injured organ. Most surgeries were performed within 24 hours, and the majority of patients were hemodynamically stable. Postoperative complications, including bleeding, infection, and mortality, were within expected global ranges. Limitations of the Study: This study has several limitations. First, as a retrospective single-center study, the findings may not be generalizable to other populations or healthcare settings. Second, the quality and completeness of data depended on the accuracy of documentation in medical records. Third, some variables such as detailed injury mechanisms or long-term outcomes could not be consistently assessed due to missing follow-up data. Declarations Conflict of Interest Statement: The author declares that there are no conflicts of interest—financial, personal, or professional—that could have influenced the design, conduct, or outcomes of this study. Ethical Approval: Ethical approval for this study was obtained from the Ethics Committee of Al-Mouwasat University Hospital, Damascus, Syria. The protocol was reviewed and approved under decision number EMH-2024/097 on December 15, 2024. All procedures involving patient data were conducted in accordance with institutional and international ethical standards, ensuring full confidentiality and anonymity. Authors’ Contributions: Dr. Bassam Nayef Maanieh contributed to the study design, data collection, and overall supervision of the research. Dr. Anas Muhammad Murad was responsible for data analysis and drafting the initial manuscript. Dr. Abdulrahman Hamadiyah participated in literature review, discussion of results, and preparing the final manuscript. All authors have read and approved the final version of the manuscript and take full responsibility for the content of the study. Acknowledgments: The author would like to express sincere gratitude to the academic supervisors and the staff of the General Surgery and Emergency Departments at Al-Mouwasat University Hospital for their scientific guidance and logistical support. Appreciation is also extended to the medical records team for their cooperation in providing access to patient data, which was essential for completing this study. Data Availability Statement: The data supporting the findings of this study were collected from patient records at Al-Mowasat University Hospital. Due to privacy and ethical restrictions, the raw data are not publicly available. However, anonymized data may be made available by the author upon reasonable request and with permission from the hospital’s ethics committee. References Feliciano DV (2017) Abdominal trauma revisited. Am Surg 83(11):1193–1202 Demetriades D, Velmahos GC (2000) Penetrating injuries of the abdomen: current evaluation and management. Ann Surg 231(4):390–402 American College of Surgeons Committee on Trauma (2018) Advanced Trauma Life Support (ATLS®): Student Course Manual, 10th edn. ACS, Chicago Richards JR, Derlet RW (2017) Focused assessment with sonography in trauma (FAST) in 2017: what radiologists can learn. Radiology 283(1):30–48 Leppäniemi A, Haapiainen R (1996) Selective nonoperative management of abdominal stab wounds: prospective, randomized study. World J Surg 20(9):1101–1106 Velmahos GC, Demetriades D, Toutouzas KG et al (2001) Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy be abandoned? Ann Surg 234(3):395–403 Weinberg JA et al (2021) Penetrating abdominal trauma: Epidemiology and outcomes in a high-income country. Injury 52(6):1234–1240 Ranjan P et al (2020) Clinical outcomes of penetrating abdominal trauma: A retrospective analysis. J Trauma Manag Outcomes 14:22 Traoré A et al (2019) Abdominal trauma in a sub-Saharan hospital: A 10-year experience. Pan Afr Med J 34:171 Naqvi IH et al (2017) Management of abdominal trauma in low-resource settings. World J Emerg Surg 12:20 Pradhan S et al (2022) Outcomes of exploratory laparotomy in abdominal trauma: A tertiary center experience. Int Surg J 9(5):1243–1249 Additional Declarations The authors declare potential competing interests as follows: The author declares that there are no conflicts of interest—financial, personal, or professional—that could have influenced the design, conduct, or outcomes of this study. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6719526","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":460096327,"identity":"f7017c52-0dff-4cdf-a9b0-3cccc626dfd7","order_by":0,"name":"Bassam Nayef Maanieh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACAwYG9h8JFTb1/SBeQgFxWhgkHpxJY5zZANJiQKQWyYcthxg3HIBxCQFzscMPDBIbDjAbn1+d+OGBAYM8v9gB/FosZ6cZJCTuuMNmduPtZgmgwwxnzk4g4LDbCQYHEs884zG7cXYDSEsCUISQlvSPDYlthyWMZ5zd/INILTnGDEAtBgb8vduIs8Vydk4ZQ8KZtASJG7zbLBIMJAj7xVw6fRvjjwqbBP7+s5tvAhny/NIEtCCABFilBLHKQYD/ACmqR8EoGAWjYCQBAGkSS0hwRBWwAAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of medicine, AL-Sham Private University, Damascus, Syria.","correspondingAuthor":true,"prefix":"","firstName":"Bassam","middleName":"Nayef","lastName":"Maanieh","suffix":""},{"id":460096328,"identity":"de6b4b0f-810d-4400-a18b-c868243a92f2","order_by":1,"name":"Anas Muhammad Murad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYHCD5AMHJCqANDNzA7Fa0hIPWJwBaWEkWkuO8YHKNhCDgBb+2c2PPzDmHM7nb88xOHBzXm00fztQy4+KbTi1SNw5ZibBuO2w5YwzzwoOztx2PHfGYcYGxp4zt3FbcyPBjAGoxYDhRvKGw5LbjuU2ALUwM7bh1iJ/I/3zB5AW+RsJBof/zjmWO5+QFoMbOQYghxkY3EgxOCDZUJO7gZAWwxs5ZRKJ29INDM88SzggcexA7kagloP4/CJ3I33zh4/brA3kjicf/iBRU5c77/zhgw9+VODxPggkIJiHweQB/OpRQR0pikfBKBgFo2CEAADiTmVWrREYEgAAAABJRU5ErkJggg==","orcid":"","institution":"Faculty of medicine, AL-Sham Private University, Damascus, Syria.","correspondingAuthor":true,"prefix":"","firstName":"Anas","middleName":"Muhammad","lastName":"Murad","suffix":""},{"id":460096329,"identity":"c65592f9-5297-40a0-be61-09da6b450e87","order_by":2,"name":"Abdulrahman Ahmad Hammadieh","email":"","orcid":"","institution":"Consultant of General and Laparoscopic Surgery at Damascus University, Damascus, Syria.","correspondingAuthor":false,"prefix":"","firstName":"Abdulrahman","middleName":"Ahmad","lastName":"Hammadieh","suffix":""}],"badges":[],"createdAt":"2025-05-21 21:27:46","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6719526/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6719526/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83319763,"identity":"cfe2c8d8-e740-4b9f-a90b-4d1d15c8f545","added_by":"auto","created_at":"2025-05-23 03:21:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":525118,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6719526/v1/104e979b-40a7-422a-9fb8-08667d5b1ae2.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: The author declares that there are no conflicts of interest—financial, personal, or professional—that could have influenced the design, conduct, or outcomes of this study.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eManagement of penetrating abdominal trauma\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":" \u003cp\u003ePenetrating abdominal trauma is a critical emergency frequently encountered in trauma and surgical units, primarily resulting from stab wounds and gunshot injuries. These injuries involve the entry of a sharp or high-velocity object into the peritoneal cavity, often damaging internal organs such as the liver, intestines, spleen, or major blood vessels. The initial assessment and management are guided by the Advanced Trauma Life Support (ATLS) principles, with rapid identification of hemodynamic instability or peritoneal signs being crucial for determining the need for urgent surgical intervention [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e][\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile unstable patients typically require immediate exploratory laparotomy, stable patients may undergo selective nonoperative management supported by diagnostic tools like Focused Assessment with Sonography in Trauma (FAST) and contrast-enhanced computed tomography (CT) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e][\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Advances in imaging and clinical algorithms have enabled a more conservative approach in select cases, minimizing unnecessary surgeries and associated morbidity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e][\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aims to evaluate the clinical presentation, diagnostic approach, and outcomes of patients with penetrating abdominal trauma, and to assess the effectiveness of different management strategies (operative vs. nonoperative) based on hemodynamic status and mechanism of injury.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting:\u003c/h2\u003e \u003cp\u003eThis study was conducted using a retrospective design in the Emergency Department of the General Surgery Division at Al-Mouwasat University Hospital in Damascus. The study period extended from January 1, 2022, to December 31, 2024. It included patients who presented to the hospital with a history of penetrating abdominal trauma and were managed within the General Surgery Division during the specified period.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion Criteria:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePatients who were evaluated and treated in the General Surgery Division and Emergency Department at Al-Mouwasat University Hospital.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatients aged between 10 and 70 years.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion Criteria:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePatients with multiple trauma.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatients younger than 10 years or older than 70 years.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatients with major abdominal vascular injuries or injuries to the urinary tract.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eData Collection Tool:\u003c/h3\u003e\n\u003cp\u003eA paper-based data collection form was used to extract clinical and demographic data from the medical records of the included patients. The form was designed to capture a set of core variables related to the clinical status of the patient and the surgical intervention performed. It began with general demographic data such as age and gender, followed by variables related to the timing of surgical intervention, specifically the time interval (in hours) between injury occurrence and surgical intervention.\u003c/p\u003e \u003cp\u003eInitial hemodynamic status at presentation (stable/unstable) was recorded, in addition to the cause of injury (e.g., stab wound, gunshot, or other sharp object). The form also included classification of the trauma pattern based on the entry site and the number of wounds, with accurate documentation of the injured organs.\u003c/p\u003e \u003cp\u003eFor clinical analysis purposes, the form incorporated both qualitative and quantitative classifications of injury severity, with grading of organ-specific injuries according to standard surgical scales (e.g., AAST classification, where available in the records). Lastly, complications occurring during the treatment period were documented, including hemorrhage, infection, intestinal leakage, the need for reoperation, or other clinically relevant adverse outcomes.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eOnly descriptive statistical analysis was performed. Categorical variables were summarized using frequencies and percentages, while continuous variables (e.g., age, time interval to surgery) were expressed as means and standard deviations. Data were processed using either Microsoft Excel or SPSS software, as appropriate.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included a sample of 122 patients who suffered from penetrating abdominal trauma during the specified study period. Demographic, clinical, and surgical data were analyzed based on several key variables.\u003c/p\u003e\n\u003ch3\u003eAge and Gender Distribution:\u003c/h3\u003e\n\u003cp\u003eThe results showed that the majority of patients were male, with 106 male patients (87%) compared to only 16 female patients (13%), indicating a clear predominance of penetrating abdominal injuries among males.\u003c/p\u003e \u003cp\u003eRegarding age distribution, patients were categorized into six age groups with 10-year intervals. The most represented group was the 21\u0026ndash;30 years\u0026rsquo; age group, which included 54 patients (44.26%). This was followed by the 31\u0026ndash;40 and 41\u0026ndash;50 years\u0026rsquo; groups, each with 16 patients (13.11%). The 51\u0026ndash;60 age group included 14 patients (11.48%), while the youngest group (10\u0026ndash;20 years) included 12 patients (9.84%). The oldest group (61\u0026ndash;70 years) consisted of 10 patients (8.20%). This distribution reflects that the majority of injuries occurred in economically and socially active individuals.\u003c/p\u003e\n\u003ch3\u003eTime Interval Between Injury and Surgery:\u003c/h3\u003e\n\u003cp\u003eAnalysis showed that 104 patients (93%) underwent surgical intervention within less than 24 hours from the time of injury, while only 8 patients (7%) received surgery after more than 24 hours. This demonstrates a relatively rapid response in managing penetrating abdominal injuries, which often require urgent surgical intervention to avoid complications.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eHemodynamic Stability Upon Admission:\u003c/h2\u003e \u003cp\u003eIn terms of hemodynamic status at the time of admission, 104 patients (85%) were classified as stable, while 18 patients (15%) presented in an unstable condition, indicating the presence of significant intra-abdominal vascular injuries in a considerable proportion of cases. Stability was determined immediately upon arrival at the emergency department, based on vital signs (blood pressure and heart rate), and considering age, gender, and weight.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCause of Injury:\u003c/h2\u003e \u003cp\u003eThe causes of injury varied among patients. The most common cause was gunshot wounds, accounting for 40 cases (33%). This was followed by blast injuries with 32 cases (26%), and other sharp objects such as knives. These findings reflect the impact of environmental and security conditions on the nature of recorded injuries.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eIntraoperative Evaluation of Injuries:\u003c/h2\u003e \u003cp\u003eAll patients underwent exploratory laparotomy to identify the type and extent of injury. The small intestine was the most commonly injured organ, involved in 42 cases (34.4%), followed by the spleen in 40 cases (32.7%), and the liver in 15 cases (12.3%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInjury Severity Classification According to AAST:\u003c/h2\u003e \u003cp\u003eInjury severity was classified using the American Association for the Surgery of Trauma (AAST) grading system. In cases of multiple injuries, the highest severity grade was recorded for analysis:\u003c/p\u003e \u003cp\u003eStomach Injuries: A total of 7 cases were documented. Most were Grade II (4 patients, 57.1%), followed by Grade III (2 patients, 28.6%), and one case was Grade I (14.3%).\u003c/p\u003e \u003cp\u003eSmall Intestine Injuries: Of the 42 cases, 22 were Grade III (52.3%), 15 were Grade II (35.7%), and 5 were Grade I (13%).\u003c/p\u003e \u003cp\u003eColon Injuries: Out of 12 cases, 6 were Grade III (50%), while both Grade I and Grade II had 3 cases each (25%).\u003c/p\u003e \u003cp\u003eLiver Injuries: Among 15 cases, the majority were Grade I (33.3%), followed by Grade II (26.7%), and Grade III (20%). Higher grades (IV and V) were less common.\u003c/p\u003e \u003cp\u003eSpleen Injuries: Of 40 cases, 18 were Grade IV (45%), 7 were Grade V (17.5%), 6 were Grade II (15%), 5 were Grade III (12.5%), and 4 were Grade I (10%).\u003c/p\u003e \u003cp\u003ePancreatic Injuries: Out of 6 cases, both Grade III and IV were the most frequent (2 patients each, 33.3%), while Grade I and V each had 1 case (16.7%). No Grade II injuries were observed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative Complications:\u003c/h2\u003e \u003cp\u003ePostoperative complications were assessed, including hemorrhage, infection, and mortality:\u003c/p\u003e \u003cp\u003eHemorrhage: Occurred in 10 patients (8.2%).\u003c/p\u003e \u003cp\u003eInfection (sepsis): Reported in 18 patients (14.75%).\u003c/p\u003e \u003cp\u003eMortality: 8 patients died, representing 6.56% of the total sample.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study included 122 patients, selected after the exclusion of 10 cases that did not meet the inclusion criteria. Demographic analysis revealed that the majority were male (87%), while females represented 13% of the cohort. The most affected age group was between 21 and 30 years, reflecting a common epidemiological pattern in traumatic injuries affecting young, active individuals.\u003c/p\u003e \u003cp\u003eRegarding the timing of surgical intervention, 93% of patients underwent surgery within less than 24 hours from the time of injury. This indicates efficient emergency surgical response and is associated with improved clinical outcomes. Hemodynamically, 85% of patients were stable upon admission, which allowed for appropriate surgical preparation and evaluation.\u003c/p\u003e \u003cp\u003eThe leading cause of injury was gunshot wounds, accounting for 33% of cases, followed by explosive injuries at 26%. This pattern reflects the geopolitical and security context in which the study was conducted. In terms of injured organs, the small intestine was the most commonly affected (34.4%), followed by the spleen (32.7%), consistent with mechanisms of penetrating trauma, which typically affect hollow and vascular organs. The American Association for the Surgery of Trauma (AAST) classification was used to grade organ injuries. The main findings were as follows:\u003c/p\u003e \u003cp\u003eFor gastric injuries, the majority were grade 2 (57.2%). For small bowel injuries, grade 3 was most frequent (52.3%). For colonic injuries, grade 3 predominated (50%). In hepatic injuries, grade 1 was most common (33.3%). For splenic injuries, grade 4 was most frequently observed (45%). In pancreatic injuries, the most common grades were 3 and 4 (33.3% each). Postoperative complications included bleeding in 10 cases (8.2%), surgical site infection in 18 cases (14.7%), and postoperative mortality in 8 cases (6.5%).\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eComparison with Similar International Studies:\u003c/h2\u003e \u003cp\u003eThe findings of this study are in agreement with several international peer-reviewed studies concerning the epidemiological distribution. Five studies reported that the 21\u0026ndash;30-year age group was the most affected by abdominal trauma, with a clear predominance of males (approximately 85\u0026ndash;90%) [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, there were notable differences in the mechanism of injury. While road traffic accidents were the leading cause in most international reports\u0026mdash;such as in the studies by Weinberg et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and Ranjan et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u0026mdash;explosive injuries and gunshot wounds were more frequent in our cohort, likely reflecting contextual and environmental differences.\u003c/p\u003e \u003cp\u003eIn terms of injured organs, this study aligns with global literature in identifying the small intestine as the most commonly affected organ in penetrating abdominal trauma, as reported by Traor\u0026eacute; et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and Naqvi et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe incidence of postoperative hemorrhage in our study was 8.2%, similar to international ranges (6\u0026ndash;10%) [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, the rate of surgical site infections (14.7%) was higher than that observed in comparable studies, such as Pradhan et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], which reported a rate of 9.5%. This discrepancy may be attributed to differences in surgical sterility, resource availability, or postoperative care protocols.\u003c/p\u003e \u003cp\u003eThe mortality rate in our cohort was 6.5%, comparable to those reported by Naqvi (6%) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], Ranjan (5%) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], Weinberg (7%) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and Traor\u0026eacute; (10%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], but higher than in Pradhan\u0026rsquo;s study (2%) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These differences could be due to variations in injury severity, patient triage systems, or institutional treatment guidelines.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reviewed 122 cases of penetrating abdominal trauma treated surgically at a tertiary care center. Young adult males aged 21\u0026ndash;30 years were the most affected group. Gunshot wounds were the leading cause of injury, followed by explosive trauma. The small intestine was the most frequently injured organ. Most surgeries were performed within 24 hours, and the majority of patients were hemodynamically stable. Postoperative complications, including bleeding, infection, and mortality, were within expected global ranges.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study:\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, as a retrospective single-center study, the findings may not be generalizable to other populations or healthcare settings. Second, the quality and completeness of data depended on the accuracy of documentation in medical records. Third, some variables such as detailed injury mechanisms or long-term outcomes could not be consistently assessed due to missing follow-up data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of Interest Statement:\u003c/h2\u003e \u003cp\u003eThe author declares that there are no conflicts of interest\u0026mdash;financial, personal, or professional\u0026mdash;that could have influenced the design, conduct, or outcomes of this study.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthical Approval:\u003c/h2\u003e \u003cp\u003e Ethical approval for this study was obtained from the Ethics Committee of Al-Mouwasat University Hospital, Damascus, Syria. The protocol was reviewed and approved under decision number EMH-2024/097 on December 15, 2024. All procedures involving patient data were conducted in accordance with institutional and international ethical standards, ensuring full confidentiality and anonymity.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthors\u0026rsquo; Contributions:\u003c/h2\u003e \u003cp\u003eDr. Bassam Nayef Maanieh contributed to the study design, data collection, and overall supervision of the research. Dr. Anas Muhammad Murad was responsible for data analysis and drafting the initial manuscript. Dr. Abdulrahman Hamadiyah participated in literature review, discussion of results, and preparing the final manuscript. All authors have read and approved the final version of the manuscript and take full responsibility for the content of the study.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eThe author would like to express sincere gratitude to the academic supervisors and the staff of the General Surgery and Emergency Departments at Al-Mouwasat University Hospital for their scientific guidance and logistical support. Appreciation is also extended to the medical records team for their cooperation in providing access to patient data, which was essential for completing this study.\u003c/p\u003e\u003ch2\u003eData Availability Statement:\u003c/h2\u003e \u003cp\u003eThe data supporting the findings of this study were collected from patient records at Al-Mowasat University Hospital. Due to privacy and ethical restrictions, the raw data are not publicly available. However, anonymized data may be made available by the author upon reasonable request and with permission from the hospital\u0026rsquo;s ethics committee.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFeliciano DV (2017) Abdominal trauma revisited. Am Surg 83(11):1193\u0026ndash;1202\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemetriades D, Velmahos GC (2000) Penetrating injuries of the abdomen: current evaluation and management. Ann Surg 231(4):390\u0026ndash;402\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican College of Surgeons Committee on Trauma (2018) Advanced Trauma Life Support (ATLS\u0026reg;): Student Course Manual, 10th edn. ACS, Chicago\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichards JR, Derlet RW (2017) Focused assessment with sonography in trauma (FAST) in 2017: what radiologists can learn. Radiology 283(1):30\u0026ndash;48\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLepp\u0026auml;niemi A, Haapiainen R (1996) Selective nonoperative management of abdominal stab wounds: prospective, randomized study. World J Surg 20(9):1101\u0026ndash;1106\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVelmahos GC, Demetriades D, Toutouzas KG et al (2001) Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy be abandoned? Ann Surg 234(3):395\u0026ndash;403\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeinberg JA et al (2021) Penetrating abdominal trauma: Epidemiology and outcomes in a high-income country. Injury 52(6):1234\u0026ndash;1240\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRanjan P et al (2020) Clinical outcomes of penetrating abdominal trauma: A retrospective analysis. J Trauma Manag Outcomes 14:22\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTraor\u0026eacute; A et al (2019) Abdominal trauma in a sub-Saharan hospital: A 10-year experience. Pan Afr Med J 34:171\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaqvi IH et al (2017) Management of abdominal trauma in low-resource settings. World J Emerg Surg 12:20\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePradhan S et al (2022) Outcomes of exploratory laparotomy in abdominal trauma: A tertiary center experience. Int Surg J 9(5):1243\u0026ndash;1249\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"bb51f82a-ef97-4c04-9230-39ba7a9b15ff","identifier":"10.13039/100016418","name":"B.K. Kee Foundation","awardNumber":"0507547152","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Al-Sham Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Penetrating injury, exploratory laparotomy, intestinal trauma, AAST score","lastPublishedDoi":"10.21203/rs.3.rs-6719526/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6719526/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Penetrating abdominal trauma is a common surgical emergency requiring prompt intervention to reduce morbidity and mortality. This study aimed to evaluate the patterns of intra-abdominal injuries resulting from penetrating trauma in a teaching hospital setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e We conducted a retrospective study including 122 patients treated at Al-Mouwasat University Hospital between 2022 and 2024. Clinical and demographic data were collected from patient files using a structured paper-based questionnaire. Data were analyzed using descriptive statistics via SPSS software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The majority of patients were male (87%), and the most affected age group was 21–30 years. Surgical intervention was performed within 24 hours in 93% of cases, and 85% of patients were hemodynamically stable at admission. The most common cause of injury was gunshot wounds (33%), followed by blast injuries (26%). The small intestine was the most frequently injured organ (34.4%), followed by the spleen (32.7%). Postoperative complications included bleeding in 8.2%, infection in 14.7%, and mortality in 6.5% of patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Early surgical intervention and detailed assessment of injury patterns significantly contribute to better patient outcomes. Our findings partially align with international data, with local variation in injury mechanisms.\u003c/p\u003e","manuscriptTitle":"Management of penetrating abdominal trauma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-23 03:21:21","doi":"10.21203/rs.3.rs-6719526/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"406670ee-7c3c-461f-b09f-aeca54822676","owner":[],"postedDate":"May 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":48876178,"name":"General Surgery"}],"tags":[],"updatedAt":"2025-05-23T03:21:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-23 03:21:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6719526","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6719526","identity":"rs-6719526","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}