Epidemiology and surgical management of abdominal war injuries in Sarajevo: State Hospital of Sarajevo experience.

Background: In war, abdominal injuries constitute a significant proportion of the total injuries. These injuries are associated with high mortality and their treatment poses diagnostic, surgical, and therapeutic dilemmas. This article presents the epidemiology of abdominal war injuries during the siege of Sarajevo, and briefly describes the surgical techniques and therapeutic practices used in their treatment.

Methods: A retrospective medical record review was performed of 273 war casualties with trauma to visceral and vascular structures in the abdomen inflicted during a 7.5 month period in 1992.

Results: Most patients underwent exploratory laparotomy. Six percent had negative laparotomies, and there were no deaths in this group. In 18.3%, injuries were limited to one organ system, while 81.7% sustained combined injuries to multiple-organ systems. The crude mortality rate was 26.0%. Mortality rate excluding deaths within 24 hours of injury was 10.3%. Injuries were caused by metal fragments from artillery shrapnel, mortar and contact mines, or hand grenades. Because of a shortage of colostomy bags, resections of the colon with primary end-to-end anastomoses rather than colostomy were performed in 72% of the cases.

Conclusions: Mortality was highest in those victims with four or more injured organ systems (81.3%) or with major vascular injuries (64.7%). The primary cause of death within the first 24 hours was prolonged hemorrhagic shock.