Civilian Gunshot Injuries of the Abdomen at Hajjah Governorate in Yemen

Background: Civilian gunshot injuries of the abdomen become a global problem and constitute enormous emotional, physical, financial and social burden. The true magnitude of this problem in Yemen is not explored yet. Aim: The purpose of this study is to identify the pattern of civilian abdominal gunshot injuries and evaluate outcome of the management. Methods: All patients operated for penetrating gunshot of the abdomen in Saudi hospital at Hajjah governorate from June 2013 to September 2016 were included. Data of patients were prospectively recorded and analyzed to identify the pattern of abdominal gunshot injuries and evaluate the management outcome. Patients assigned to observation were excluded. Results: Eighty-five patients were enrolled. They were 71 men and 14 women with age ranging from 10 to 60 years. Small bowel was the most common affected organ, 52 patients (61.1%) followed by the colon in 24 patients (28.2%), then diaphragm in 19 patients (22.3%) and then comes liver in 15 patients (17.8%). Spleen, kidneys, great vessels and rectum were at 11.7%, 9.4%, 8.2% and 5.9% respectively. Duodenum, pancreas and urinary bladder were the least affected organs, 2 cases for each. Forty patients (47%) had bullets' entrance through anterior abdominal wall. Personal conflicts and tribal clashes were the leading events of abdominal gunshot, 48 cases (56.5 %) followed by mishandling with handguns, 11cases (12.9%). The commonest surgical procedures performed were resection and anastomosis for small bowel, resection and colostomy for the colon and primary repair for diaphragmatic injury. Splenectomy was performed in 6 patients, partial gasterectomy in 5 patients, and nephrectomy in one patient. Chest tubes were inserted in 44 patients. Postoperative complications were recorded in 35 patients (41.1%). The death rate was at 8.2%. Wound infection was recorded in 16 patients. Conclusion: Small bowel was the most common organ involved by gunshot, followed by colon, diaphragm and liver respectively. Duodenum, pancreas and urinary bladder were the least. The majority of patients were injured during personal conflicts or tribal clashes. Lack of sufficient laws governing the firearms possession and easy access to weapons without restriction is the primary cause of the problem. Therefore, serious regulations of the use of firearms to settle disputes and strict enforcement of laws to combat this trend are extremely important and needed.