In the current study, all patients before including in this research had the experience of pre-hospital setting, with proper alertness and with fluid and drug treatment. The most affected area was the umbilical region and the causes of mortality were traumas to the right lower quadrant of the abdomen caused by explosions. Most diagnostic procedures for patients included a complete blood count and urine analysis test.
The most severe damage was related to the spleen and the most common organ damaged was the small intestine. The ICD10 code indicated that the most damage was done to the small intestine and the least damage was to the bladder. The most therapeutic treatment in the hospital was conservative and no foreign body was placed for any of the traumatic patients. There were three deaths and all deaths were due to penetrating trauma with severe AIS = 2 damage to the small intestine, and the most related injury with abdominal trauma was lower limp quiver.
The results of this study showed that the most frequent intervention was the laparotomy. Mohebbi et al. (2008), assessed the frequency of gunshot and quiver injuries during the imposed war, stated that laparotomy was one of the main diagnostic measures (8). Saghafinia et al. (2010), performed to determine the frequency of surgeries performed during the 8 years of the Iran-Iraq war, it was noted that laparotomy was the most frequent surgery (11).
The high number of laparotomy surgery is similar to the results of the present study. The rational justification for a high number of laparotomy procedures can be due to severe traumas caused by the blast around the abdominal area, gunshot, and secondary laparotomy due to primary laparotomy complications (such as bleeding, fistula, peritonitis, abscess, etc.). On the other hand, the results of this study showed that most abdominal traumas were caused by explosions Penn-Barwell et al. (2015) showed that the most therapeutic interventions for penetrating trauma included the conservative ones and patient follow-up (4). This finding is consistent with the results of the present study. On the other hand, the results of this study showed that most abdominal traumas were caused by penetration and explosion. Some studies mentioned that the most frequent type of trauma was the penetrative type (12, 13). Despite the similarity of the results of the mentioned studies in terms of the type of penetrating trauma, the environment and the cause of trauma were different from the present study as traumas occurred in those studies in the city and the causes of trauma were traffic accidents and stabbings. However, in the present study, the damage was caused by close and ground battles due to suicide attacks, mortars, grenades and surface-to-surface missiles.
According to the mechanism of weapons, parts and explosive debris spread in different directions and cover a larger area, which can be overwhelming. Evidence showed the most important causes of civilian trauma included traffic accidents, fall from heights, and winning objects (14, 15). In the present study; most of the traumas were infiltrated and caused by explosions and bullets, which is different from the results of the mentioned research. Perhaps the main reason for this difference is the difference in the research community, in the present study, the research community included patients with abdominal trauma- sustained during the war and in war conditions. The high incidence of small intestine trauma could be due to inadequate use of bulletproof vests, lack of taking a trench, and greater distribution of small intestine in the abdominal space than other organs.
Raja'i et al. (2012), showed that the peritoneum and mesentery were the most injured organs in patients with abdominal trauma (10). Also, the results of the study of Moti´e et al, which was performed to survey patients with severe trauma showed that the spleen was the most damaged organ and the most common type of trauma was blunt (18). The reason for the difference between the results of these studies and the present study can be explained by the differences between the environments of trauma as trauma occurred in those mentioned studies in the city and the cause of trauma was mostly traffic accidents and stabbing, but in this study the trauma occurred in the war zones and was caused by firearms and explosives. In the current study there was a statistically significant relationship between the trauma mechanism, injuries accompanying the abdominal trauma and outcome of the patient. However, the study by Mobaleghi, et al. (2004) showed there was no statistically significant relationship between the pattern of trauma and the patient's outcomes (19).
The results of current study showed that the rate of wound infection was %30, whereas in the Störmann et al. (2016) showed the rate of wound infection was %7.8 (20). The reason for this discrepancy may be related to the nature and differences between civilian and military trauma conditions. After a bullet strikes the body, explosive waves enter the bullet's path and travel at the speed of sound, creating a vacuum within the body that passes through the body, causing the foreign bodies adjacent to the wound, such as soil, clothing, wood, iron. Parts of the thermos easily penetrate deep into the wound and cause localized neurovascular damage due to the vacuum that is responsible for the wound infection.
The mortality rate in the current study was about %2.9. Saghfinia et al. (2009) investigated the prevalence of abdominal injuries in warfare victims and reported a low incidence of mortality (3). Nourian et al. (2010) showed that the mortality rate of patients was %2.9 on patients undergoing treatment for penetrating chest trauma (21). This result is consistent with the findings of the current study. The similarity of these results could be due to early diagnosis, accurate follow-up, management and quality of health care and exact triage in two studies.