Abdominal Trauma Management: About 62 Cases at the Department of General Surgery of Hôpital Sominé DOLO de Mopti, Mali

We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases in our surgery department. Overall, abdominal trauma represented 3.54% (62/1751) of all surgeries during the study period. Among the 62 cases, men accounted for 59 and women for 3. The sex ratio was 19.67. The mean age was 24 ± 15 years. Road accidents were the most represented with 43.5% of cases. The couple of signs, hypovolemic cedures when it came to deal with contusions. Debridement of wounds plus suture and hemostasis by tamponade was performed in 18.73% and 4.16 cases, respectively. The most observed lesions were those of the spleen with 27.42% and those of the small bowel with 24.19%. The postoperative fol-low-up was straightforward in 83.33% of cases. The overall mortality was 4.17%.


Introduction
Abdominal trauma (AT) is defined as a contusion and/or a wound of the abdomen. Contusion is a closed trauma without a solution of continuity between the peritoneal cavity and the outside [1]. Wounds correspond to a communication traumatic of the peritoneal cavity with the exterior via a wounding agent (firearm, bladed weapon) [1]. Injuries from violence or accidents are the second leading cause of death in the world [2]. This mortality is directly related to the severity of the trauma and the delay in treatment [2]. In France, bladed weapons are the main agents involved [3] and penetrating trauma is infrequent (10% to 15%) of all trauma [4]. In the United States, abdominal trauma accounts for up to 70% of trauma, with a majority of gunshot wounds [4]. All intra-abdominal organs can be affected during an abdominal contusion ranging from rupture of solid organs (Liver; Spleen; Kidneys; Pancreas) to hollow organs (aorta; vena cava; mesentery) which are responsible for internal bleeding [1]. Damage to hollow organs results in peritonitis. In traumatic wounds of the abdomen, the most common wounding agents are bladed weapons, firearms and explosive agents.
Visceral lesions can be single or multiple with a path defined by the injuring agent. All intra-abdominal organs mobile or fixed can be affected [1]. The aim of this work was to determine the typology and the management of abdomen trauma at Hôpital Sominé DOLO de Mopti.

Patients and Methods
This was an observational prospective and descriptive study by successive recruitment from February 1, 2016 to August 31, 2017. It was performed in the general surgery department of Hôpital Sominé DOLO de Mopti. We enrolled all the patients admitted to our department for abdominal trauma with lesions and having given their informed consent or assent. Were not enrolled those patients admitted for other reasons than abdominal trauma or who did not give their consent. The parameters studied were: interview data for those who were conscious, physical examination, paraclinical data and those of intra and post-operative follow-up.
Data were collected from survey sheets, medical records, outpatient records,

Results
Out of 1751 patients received, 62 were victims of AT i.e. 3.54%. The sex ratio was 19.67. The age groups 11 -20 followed by 21 -30 were the most affected with 44.0% and 16.0%, respectively. The mean age was 24 ± 15 years with extremes ranging from 6 and 70 years old (Figure 1(a)). Road accidents 43.54% and criminal assaults 19.35% were the predominant circumstances of the occurrence of AT (Table 1) Table 3). The duration of the surgery ranged from 35 to 130 minutes. The postoperative consequences were straightforward in 83.33%. The evolution was marked by a morbidity rate of 12.50% (6 cases of wall suppuration) and 4.17% of mortality. The average length of hospital stays varied according to the types of AT: for abdominal contusion from 3 to 9 days and for the wound from 3 to 13 days.

Discussion
We received 62 cases of AT out of 1751 surgical operations, ie 3.54%. Our pa-  [5]. In civilian practice, the white weapon is the most common causal agent [7]. Bladed weapons and the hoof strike in our study were found in 12. cases and antibiotic-prophylaxis. Currently, whether this is sufficient, medical treatment remains the best option for the management of AT [2]. In our study,  [12] who reported a mortality of 3.2%. The difference in mortality between our series and that of B.T et al., 2014 [11] could be linked to the small size of our sample.

Conclusion
Our data shed light on the place of AT in our structure and their link with RA increasing crime in our cities and rural work. Our results call for more caution in road traffic for young people and during field work for farmers.