Patterns and outcomes of abdominal wound injuries in Sudanese armed conflict survivors: a retrospective cohort study

Abstract

Background and aim On April 15, 2023, the people of Khartoum were woken by the drums of war. The armed conflict resulted in >1200 reported fatalities and over 12 000 injuries. The abdomen, housing vital organs and lacking protective bony structures, is highly vulnerable in such settings. Understanding abdominal wound injuries (AWIs) is essential for improving management and outcomes. This study aimed to analyze the patterns and outcomes of AWIs among survivors of the Sudanese armed conflict.Methods A retrospective cohort study was conducted at Wad Madni Teaching Hospital, Gezira State, Sudan, from April 15 to October 31, 2023. All patients with AWIs who underwent exploratory laparotomy and had complete records were included. Data were collected from medical records and analyzed using SPSS V.26. Demographic and clinical variables, mechanisms of injury, intraoperative findings, complications, and outcomes were assessed.Results Thirty-three patients were admitted with AWIs during the study period. Most were civilians (87.5%) and male (93.9%), with a mean age of 28 years. The primary mechanisms were stabbing (54.5%) and gunshots (33.3%). The small intestine (33.3%) and large intestine (30.3%) were the most affected organs. Intraoperative findings showed visceral injuries in 66.7% of cases. The mean delay from injury to admission was 27 hours (range 1–148). Combat-related injuries were more often gunshot wounds, involved multiple organs, and were associated with longer delays to admission (47 vs 19 hours, p=0.003), longer hospital stays (7 vs 5 days, p=0.009), and higher mortality (18.2% vs 0%, p=0.039). Overall postoperative mortality was 6.1%, mainly due to sepsis.Conclusion AWIs in the Sudanese conflict were predominantly penetrating, with high intestinal involvement and significant prehospital delays. Combat-related injuries were more severe and carried higher mortality. These findings highlight the need for faster referral systems, context-specific surgical strategies, and infection-control measures in resource-limited conflict zones.Level of evidence Level III (retrospective cohort study).