1. Background

According to the World Health Organization’s (WHO) global burden of injury estimate ranks injury is one of the top ten leading causes of death, with an estimated 5 million deaths annually, among which men in Africa have the highest injury-related mortality rates in the world [1]. Trauma is the second largest cause of illness, accounting for 16% of the global disease burden, and it is the highest between the ages of 15 and 45 years. According to WHO, low- and middle-income countries account for more than 90% of all injuries. Africa, mainly the Sub-Saharan region, contributes 21% of these [2].

The abdomen is vulnerable to injury since there is minimal bony protection for underlying organs [3]. The etiological spectrum and mechanism of injury of abdominal trauma, which have been reported in the literature, vary from one part of the world to another, partly because of variations in infrastructure, civil violence, wars, and crime [4]. Abdominal trauma poses a diagnostic challenge to general surgeons and professionals practicing in resource-limited countries [5].

The management of patients with abdominal trauma has several important elements: adequate prehospital care; rapid transport to a specialized Centre; complex in-hospital care; and rehabilitation. In recent years, many abdominal injuries, especially those involving solid organs are managed nonoperatively. This has been made possible by the invention of imaging techniques like ultrasonography, computerized tomography (CT) scanning, and magnetic resonance imaging (MRI), which show the site and extent of the injury [6–8].

This study aimed to assess the pattern of abdominal injuries at St Paul’s Hospital Millennium Medical College (SPHMMC) and Addis Ababa Burn, Emergency and Trauma (AaBET) hospital, Addis Ababa, Ethiopia.

2. Methodology

This hospital-based cross-sectional study was done at SPHMMC and AaBET hospitals from January 2018 to December 2019. SPHMMC is one of the tertiary referral hospitals in Addis Ababa, Ethiopia, established in 1968. The hospital serves around 15,000 emergency visits a year and has around 700 inpatient beds. AaBET Hospital is an affiliate of SPHMMC in Addis Ababa, Ethiopia, established in 2015 for quality improvement to improve emergency, burn, and trauma care. The hospital provides emergency, critical care, general surgery, neurosurgery, and orthopedic service.

In this study, we included all patients clinically diagnosed to have an abdominal injury who presented to SPHHMC/AaBET Hospital from January 2018 to December 2019. Patients who died before diagnosis and patients treated at other hospitals and referred for other reasons were excluded.

3. Results

4. Discussion

Abdominal trauma continues to be a major cause of trauma admission all over the world and contributes significantly to high morbidity and mortality [3]. The majority of the patients in this study are in their 2^nd to 4^th decade of life, which represents the economically productive age group in Ethiopia, and this finding conforms to observations made by a study from Tanzania [9]. Even though we did not assess use of alcohol and drugs, other studies suggest high use in this age group [10].

In this study, more males (75.3%) were affected than females, with a male-to-female ratio of 5.6 : 1, and this is also comparable with other studies done in our setting [11]. This might be due to male’s engagement in high-risk activities; and male are bread earners of most households and are probably more involved in activities that predispose them to get injured in the process of trying to earn a living and the young age group being the mobile population more involved in recreational activities like other studies [12].

In our study, penetrating trauma was the leading mechanism of abdominal injury which is in agreement with other studies [13–18]. Contrary to the above studies other researchers showed blunt injury is more common than penetrating [9, 19]. This variation could be because of variations in the mechanism of trauma [20].

Road traffic accidents, stab injuries, and gunshots were the main causes of abdominal trauma, similar to other studies [11, 13, 21]. This requires national policies and implementations to decrease road traffic accidents, stab injuries, and gunshots.

Polytrauma, followed by chest and pelvic trauma, were the three main associated traumas in patients with abdominal trauma in this study. Higher associated polytrauma and a chest injury in abdominal trauma are linked with higher mortality in different studies [22].

The operative rate in the current study was 79.4%, a figure which is comparable with that Kenyatta National Hospital (70%) [18]. In operated patients, the spleen was found to be the most commonly injured intraabdominal organ in blunt abdominal injuries, whereas the colon and small bowel were injured most in penetrating abdominal injuries like in other studies [23].

If there is no apparent evidence for laparotomy, nonoperative therapy of abdominal trauma differs depending on the kind of injury (blunt or penetrating), hemodynamic condition, FAST findings, and CT scan results. Follow-up of abdominal conditions, serial hematocrit determination, ultrasound/CT if required, and admission to the observation area are all part of the nonoperative care of blunt abdominal injuries in hemodynamically stable patients without bowel injury or significant solid organ injury. Nonoperative treatment for penetrating abdominal injuries is determined by hemodynamic stability, the lack of peritonitis, and the trajectory of the stabbing or shooting damage [24–27].

The mortality rate of this study was relatively better than Kenyatta National Hospital (12.5%) [18], and operated patients’ mortality in the previous same-site study (8.5%) [11]. This could be because of study inclusion criteria, injury severity differences, patient management, or clinical course.

5. Conclusion

Abdominal trauma predominantly affects the male and economically productive age. Road traffic accidents, stab injuries, and gunshots were the leading causes of abdominal injuries. The research urges the development of correct handling and usage of weapons and sharp items as well as the raising of public awareness about preventing traffic accidents.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors’ Contributions

The authors have all contributed equally to the conception of the work including the acquisition, analysis, or interpretation of data, drafting and revising, and final approval of the version to be published and agreed to be accountable for all aspects of the work.