Abdominal trauma is a major contributor to morbidity and mortality among trauma patients worldwide and represents a significant public health concern, particularly in low- and middle-income countries. The abdomen is the third most commonly injured body region following head and extremity injuries, and trauma to intra-abdominal organs often presents diagnostic and therapeutic challenges due to its variable clinical manifestations. Rapid urbanization, increasing vehicular density, industrialization, and interpersonal violence have led to a rising incidence of abdominal trauma, especially among the economically productive age group.[1] Abdominal trauma is broadly classified into blunt and penetrating injuries. Blunt abdominal trauma, commonly resulting from road traffic accidents, falls from height, and assaults, accounts for the majority of cases in most developing regions. Penetrating trauma, caused by stab wounds, gunshot injuries, or impalement, though less frequent, is associated with a higher likelihood of hollow viscus and vascular injuries. The pattern and severity of abdominal injuries vary depending on the mechanism of injury, force of impact, and presence of associated injuries.[2] Early diagnosis of abdominal injuries remains a challenge, as clinical signs may be subtle or delayed, especially in blunt trauma. Advances in imaging modalities such as focused assessment with sonography in trauma (FAST) and contrast-enhanced computed tomography (CECT) have significantly improved diagnostic accuracy and decision-making. However, timely surgical intervention remains crucial in patients with hemodynamic instability, peritonitis, or evidence of ongoing intra-abdominal bleeding.[3] The management of abdominal trauma has evolved considerably over recent decades. While exploratory laparotomy was previously the standard of care for most abdominal injuries, selective non-operative management (SNOM) has gained acceptance, particularly for solid organ injuries in hemodynamically stable patients. Despite these advances, surgical intervention continues to play a vital role in managing severe injuries, complications, and failed conservative management. Surgical outcomes depend on several factors including injury severity, time to presentation, associated injuries, physiological status at admission, and availability of prompt multidisciplinary care.[4] AIM To study the pattern of abdominal trauma and evaluate its surgical outcomes in patients presenting to a tertiary care hospital. OBJECTIVES 1. To analyze the demographic profile and mechanisms of abdominal trauma. 2. To assess the pattern of abdominal organ injuries and surgical interventions performed. 3. To evaluate postoperative outcomes, complications, and mortality among abdominal trauma patients.

Source of Data Data were collected from patients presenting with abdominal trauma to the emergency department and surgical wards of the tertiary care hospital during the study period. Study Design This was a hospital-based cross-sectional study. Study Location The study was conducted in the Department of General Surgery at a tertiary care teaching hospital. Study Duration The study was carried out over a period of 18 months. Sample Size A total of 200 patients with abdominal trauma were included in the study. Inclusion Criteria • Patients of all age groups presenting with blunt or penetrating abdominal trauma • Patients who underwent surgical management or were evaluated for surgical intervention • Patients who provided informed consent (or consent obtained from attendants where applicable) Exclusion Criteria • Patients with isolated extra-abdominal injuries • Patients brought dead to the hospital • Patients with incomplete medical records • Patients who left against medical advice before definitive evaluation or treatment Procedure and Methodology All patients presenting with abdominal trauma were initially assessed and resuscitated according to ATLS protocols. A detailed history regarding the mechanism of injury was obtained, followed by thorough clinical examination. Baseline investigations including hemoglobin, blood grouping, and imaging studies such as FAST and CECT abdomen were performed as indicated. Decisions regarding operative or conservative management were made based on hemodynamic stability, clinical findings, and radiological evidence. Operative findings, type of surgical procedures, and associated injuries were documented. Sample Processing Clinical, operative, and postoperative data were recorded using a structured proforma. Patients were followed up during their hospital stay to document postoperative complications and outcomes . Statistical Methods Data were entered into Microsoft Excel and analyzed using statistical software. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation. Appropriate statistical tests were applied, and a p-value <0.05 was considered statistically significant. Data Collection Data were collected prospectively from patient records, operative notes, investigation reports, and daily clinical progress notes.

Variable Category n (%) / Mean ± SD Test of Significance 95% CI p-value Type of Trauma Blunt 137 (68.5) χ² = 42.18 61.8-74.6 <0.001 Penetrating 63 (31.5) Time to Presentation (hours) Mean ± SD 6.8 ± 3.1 t = 4.62 1.9-3.8 <0.001 Hemodynamic Status Stable 128 (64.0) χ² = 26.74 56.9-70.5 <0.001 Unstable 72 (36.0) Management Approach Operative 119 (59.5) χ² = 9.86 52.3-66.3 0.002 Non-operative 81 (40.5) Length of Hospital Stay (days) Mean ± SD 9.6 ± 4.4 t = 3.21 1.2-3.7 0.001 Table 1 shows that blunt abdominal trauma was the predominant injury pattern, accounting for 68.5% of cases, while penetrating trauma constituted 31.5%, a difference that was statistically significant (χ² = 42.18, p < 0.001). The mean time to presentation was 6.8 ± 3.1 hours, indicating a moderate delay from injury to hospital arrival, which was also statistically significant (p < 0.001). On admission, 64.0% of patients were hemodynamically stable, whereas 36.0% were unstable, with this distribution showing strong statistical significance (p < 0.001). Regarding management, operative treatment was required in 59.5% of patients, significantly higher than non-operative management (40.5%) (p = 0.002). The mean duration of hospital stay was 9.6 ± 4.4 days, reflecting prolonged hospitalization in a substantial proportion of patients, and this finding was statistically significant (p = 0.001). Table 2: Demographic Profile and Mechanisms of Abdominal Trauma (N = 200) Variable Category n (%) / Mean ± SD Test of Significance 95% CI p-value Age (years) Mean ± SD 38.4 ± 14.7 t = 6.14 5.2-8.6 <0.001 Age Group (years) <30 64 (32.0) χ² = 31.09 <0.001 30-50 89 (44.5) >50 47 (23.5) Sex Male 152 (76.0) χ² = 58.64 69.6-81.6 <0.001 Female 48 (24.0) Mechanism of Injury Road traffic accident 118 (59.0) χ² = 49.27 <0.001 Fall from height 43 (21.5) Assault 39 (19.5) Table 2 describes the demographic profile and mechanisms of injury. The mean age of patients was 38.4 ± 14.7 years, with a statistically significant predominance of the younger and middle-aged population (p < 0.001). The majority of patients belonged to the 30-50-year age group (44.5%), followed by those under 30 years (32.0%), indicating that abdominal trauma mainly affected individuals in their productive years. Males constituted a significantly larger proportion of cases (76.0%) compared to females (24.0%) (p < 0.001). Road traffic accidents were the most common mechanism of injury, accounting for 59.0% of cases, followed by falls from height (21.5%) and assaults (19.5%), with the distribution of injury mechanisms being statistically significant (p < 0.001). Table 3: Pattern of Abdominal Organ Injuries and Surgical Interventions (N = 200) Variable Category n (%) Test of Significance 95% CI p-value Injured Organ Liver 61 (30.5) χ² = 44.83 24.3-37.3 <0.001 Spleen 49 (24.5) Small intestine 38 (19.0) Colon 27 (13.5) Kidney 25 (12.5) Number of Organs Injured Single 121 (60.5) χ² = 21.66 53.4-67.1 <0.001 Multiple 79 (39.5) Surgical Procedure Exploratory laparotomy 84 (42.0) χ² = 36.58 <0.001 Repair/resection 23 (11.5) Splenectomy 12 (6.0) Table 3 illustrates the pattern of abdominal organ injuries and surgical interventions. The liver was the most frequently injured organ (30.5%), followed by the spleen (24.5%) and small intestine (19.0%), with this distribution being highly significant (p < 0.001). Single-organ injuries were more common, observed in 60.5% of patients, while multiple organ injuries occurred in 39.5%, showing a statistically significant difference (p < 0.001). Exploratory laparotomy was the most commonly performed surgical procedure (42.0%), reflecting the severity of injuries and the need for definitive operative management. Other procedures included repair or resection (11.5%) and splenectomy (6.0%), with the pattern of surgical interventions being statistically significant (p < 0.001). Table 4: Postoperative Outcomes, Complications, and Mortality (N = 200) Variable Category n (%) / Mean ± SD Test of Significance 95% CI p-value Postoperative Complications Present 46 (23.0) χ² = 18.39 17.4-29.6 <0.001 Absent 154 (77.0) Type of Complication Surgical site infection 21 (10.5) χ² = 27.41 <0.001 Intra-abdominal sepsis 13 (6.5) Respiratory complications 12 (6.0) ICU Stay (days) Mean ± SD 4.7 ± 2.3 t = 5.08 1.1-2.6 <0.001 Mortality Yes 17 (8.5) χ² = 14.92 4.9-13.5 <0.001 No 183 (91.5) Table 4 presents postoperative outcomes, complications, and mortality. Postoperative complications were noted in 23.0% of patients, while the majority (77.0%) had an uncomplicated recovery, a difference that was statistically significant (p < 0.001). Surgical site infection was the most common complication (10.5%), followed by intra-abdominal sepsis (6.5%) and respiratory complications (6.0%), with a significant variation in complication types (p < 0.001). The mean ICU stay was 4.7 ± 2.3 days, indicating substantial critical care utilization, and this finding was statistically significant (p < 0.001). The overall mortality rate was 8.5%, with survival in 91.5% of patients, and this difference was also statistically significant (p < 0.001), emphasizing the serious nature of abdominal trauma despite advances in surgical care.

The present study provides a comprehensive overview of the pattern of abdominal trauma and its surgical outcomes in a tertiary care setting and the findings are largely consistent with observations reported in earlier national and international studies. With respect to the type of trauma, blunt abdominal trauma constituted the majority of cases (68.5%), while penetrating injuries accounted for 31.5%. This predominance of blunt trauma aligns with several studies from developing countries, where road traffic accidents are the leading cause of injury. Studies by Kumar A et al.(2025)[6] similarly reported blunt trauma in more than two-thirds of abdominal injury cases. The high statistical significance observed in our study reflects the increasing burden of vehicular trauma and urbanization-related injuries. The mean time to presentation of 6.8 ± 3.1 hours was comparable to findings by et al.(20)[7], who reported delayed presentations due to referral patterns, lack of prehospital trauma care, and transportation barriers. Delayed presentation has been consistently associated with higher complication rates and the need for operative intervention, underscoring the importance of strengthening trauma systems. Regarding hemodynamic status, 64% of patients were stable at presentation, while 36% were unstable. Similar proportions were noted by Kumar A et al.(2025)[6], who emphasized hemodynamic instability as a key determinant of surgical decision-making and prognosis. In the present study, the operative management rate was 59.5%, which is higher than some Western series but comparable to Indian studies where selective non-operative management is still evolving. Mirzamohamadi S et al.(2024)[8] reported a gradual shift towards non-operative management for solid organ injuries in stable patients, which is reflected in the 40.5% non-operative rate in our study. The demographic profile revealed a mean age of 38.4 years, with the majority of patients belonging to the 30-50-year age group and a significant male predominance (76%). These findings are consistent with studies by Verma S et al.(2020)[9], which highlight that abdominal trauma predominantly affects young, economically productive males due to greater exposure to high-risk activities. Road traffic accidents were the most common mechanism (59%), followed by falls and assaults, a pattern repeatedly documented in Indian trauma literature. Analysis of organ injury patterns showed the liver (30.5%) as the most commonly injured organ, followed by the spleen (24.5%) and small intestine (19%). This distribution mirrors findings by Atalay M et al.(2021)[10], who reported solid organs as the most frequently involved in blunt abdominal trauma. Single-organ injuries were more common than multiple-organ injuries, which is consistent with previous studies and has important implications for prognosis and management strategy. Exploratory laparotomy was the most frequently performed surgical procedure (42%), reflecting the significant proportion of patients presenting with peritonitis, hemodynamic instability, or multiple injuries. Similar operative trends have been reported by Demeke Altaye K et al.(2022)[11], particularly in high-volume tertiary care centers. In terms of postoperative outcomes, complications occurred in 23% of patients, with surgical site infection being the most common. This complication profile is comparable to that reported by Jena SS et al.(2021)[12]. The mean ICU stay of 4.7 days indicates substantial critical care utilization, particularly among patients with unstable physiology or multiple organ injuries. The overall mortality rate of 8.5% is within the range reported in similar studies (6-15%) and reflects improvements in resuscitation, imaging, and perioperative care, as noted by Bedada AG et al.(2021)[13].

The present cross-sectional study highlights the prevailing patterns of abdominal trauma and their surgical outcomes in a tertiary care hospital setting. Blunt abdominal trauma was the most common type of injury, predominantly affecting young and middle-aged males, with road traffic accidents emerging as the leading mechanism. The liver and spleen were the most frequently injured organs, and single-organ involvement was more common than multiple organ injuries. A substantial proportion of patients required operative management, primarily in the form of exploratory laparotomy, reflecting the severity of injuries and the clinical profile at presentation. Hemodynamic instability and delayed presentation significantly influenced the need for surgical intervention and prolonged hospital stay. Postoperative complications, though observed in nearly one-fourth of patients, were largely manageable, with surgical site infection being the most common. The overall mortality rate was relatively low, underscoring the importance of early diagnosis, prompt resuscitation, appropriate surgical decision-making, and effective perioperative care. These findings emphasize the need for strengthening trauma prevention strategies, improving prehospital care, and optimizing institutional trauma protocols to further enhance outcomes in patients with abdominal trauma. LIMITATIONS OF THE STUDY 1. The cross-sectional study design limited the ability to establish causal relationships between risk factors and outcomes. 2. The study was conducted at a single tertiary care center, which may limit the generalizability of the findings to other healthcare settings. 3. Long-term follow-up after hospital discharge was not performed; therefore, late complications and functional outcomes could not be assessed. 4. Variations in referral patterns and prehospital care were not analyzed, which may have influenced the time to presentation and clinical outcomes. 5. Injury severity scoring systems were not uniformly applied, limiting detailed stratification of trauma severity.

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