Monday, 02 March 2020 08:29

Civilian Gunshot Injuries of the Abdomen at Hajjah Governorate in Yemen Featured

Original Research:

Saeed Hadi Al-Bahlooli, Ali Lotf Al-Amry, Mohammed Ali Al-Shujaa, Yasser Abdurabo Obadiel



Original Research

Saeed Hadi Al-Bahlooli1*, Ali Lotf Al-Amry2, Mohammed Ali Al-Shujaa1, Yasser Abdurabo Obadiel1


1 Department of Surgery, Faculty of Medicine & Health Sciences, Thamar University, Dhamar, Yemen

2 Department of Surgery, Faculty of Medicine & Health Sciences, Sana'a University, Sana’a, Yemen

Al-Bahlooli SH, Al-Amry AL, Al-Shujaa MA, Obadiel YA. Civilian Gunshot Injuries of the Abdomen at Hajjah Governorate in Yemen. Annals of Medicine & Health.2020;2(1):1–6.



Background: Civilian gunshot injuries of the abdomen become a global problem and constitute enormous emotional, physical, financial and social burden. The true magnitude of this problem in Yemen is not explored yet.

Aim: The purpose of this study is to identify the pattern of civilian abdominal gunshot injuries and evaluate outcome of the management.

Methods: All patients operated for penetrating gunshot of the abdomen in Saudi hospital at Hajjah governorate from June 2013 to September 2016 were included. Data of patients were prospectively recorded and analyzed to identify the pattern of abdominal gunshot injuries and evaluate the management outcome. Patients assigned to observation were excluded.

Results: Eighty-five patients were enrolled. They were 71 men and 14 women with age ranging from 10 to 60 years. Small bowel was the most common affected organ, 52 patients (61.1%) followed by the colon in 24 patients (28.2%), then diaphragm in 19 patients (22.3%) and then comes liver in 15 patients (17.8%). Spleen, kidneys, great vessels and rectum were at 11.7%, 9.4%, 8.2% and 5.9% respectively. Duodenum, pancreas and urinary bladder were the least affected organs, 2 cases for each. Forty patients (47%) had bullets' entrance through anterior abdominal wall. Personal conflicts and tribal clashes were the leading events of abdominal gunshot, 48 cases (56.5 %) followed by mishandling with handguns, 11cases (12.9%). The commonest surgical procedures performed were resection and anastomosis for small bowel, resection and colostomy for the colon and primary repair for diaphragmatic injury. Splenectomy was performed in 6 patients, partial gasterectomy in 5 patients, and nephrectomy in one patient. Chest tubes were inserted in 44 patients. Postoperative complications were recorded in 35 patients (41.1%). The death rate was at 8.2%. Wound infection was recorded in 16 patients.

Conclusion: Small bowel was the most common organ involved by gunshot, followed by colon, diaphragm and liver respectively. Duodenum, pancreas and urinary bladder were the least. The majority of patients were injured during personal conflicts or tribal clashes. Lack of sufficient laws governing the firearms possession and easy access to weapons without restriction is the primary cause of the problem. Therefore, serious regulations of the use of firearms to settle disputes and strict enforcement of laws to combat this trend are extremely important and needed.

Keywords: Civilian abdominal gunshot, Pattern, Management outcomes



  1. Afuwape O, Alonge T. An audit of gunshot injuries seen in the accident and emergency department of a Nigerian tertiary hospital. West Afr J Med 2006; 25: 295-297. Availablefrom:
  2. Wintemute GJ. Firearms as cause of death in the United States, 1920–1982. J Trauma 1987; 27:532–6. Available from:
  3. Chamisa I. Civilian abdominal gunshot wounds in Durban, South Africa: a prospective study of 78 cases. Ann R Coll Surg Engl 2008; 90: 581–586. doi 10.1308/003588408X301118. 
  4. Philip J C, Bruce A L, Jens Ludwig, Ted R Miller. The Medical Costs of Gunshot Injuries in the United States. JAMA 1999; 282:447-454.
  5. Richardson J D, Davidson D, Miller F B. After the shooting stops: follow-up on victims of an assault rifle attack. J Trauma 1996;41(5):789–793. Available from: 
  6. Onuminya J E., Ohwowhiagbese E. Pattern of Civilian Gunshot Injuries in Irrua, Nigeria. SAJS-trauma 2005;43(4):170-172. Available from: 
  7. Livingston D H, Lavery R F, Lopreiato M C. Unrelating violence: an analysis of 6,322 gunshot wound patients at a Level I trauma center. J Trauma Acute Care Surg 2013; 76 (1):2–11. Available from:
  8. Feliciano D V, Burch J M, Vicky R N, Kenneth L M, George L, Jordan J R. Abdominal Gunshot Wounds. Ann Surg 1988;208(3):362-367.
  9. Malik A M, Alkadi A, Talpur KAH, Qureshi J N. The incidence, pattern and outcome of stray bullet injuries. A growing challenge for surgeons. Pak J Med Sci 2013;29(5):1178-1181. doi:
  10. Ibrahim E O, Alabi S, Obiano S. Gunshot Injuries in A North Eastern Nigerian Tertiary Hospital. Internet Journal of Surgery 2007; 16 (2):1-8. Available from: 
  11. Musau P, Jani P G, Owillah F A. Pattern and outcome of abdominal Injuries at Kenyatta National Hospital, Nairobi. East African Medical Journal 2006; 83 (1):37-43. Doi: 10.4341/eam/.v83i1.9359
  12. Ohene-Yeboah M, Dakubo J C B, Boakye F, Naeeder S B. Penetrating Abdominal Injuries in Adults seen at two Teaching hospitals in Ghana. Ghana Med. J 2010;44(3):103-108. Available from:
  13. Velmahos GC1Demetriades DFoianini ETatevossian RCornwell EE 3rdAsensio JBelzberg HBerne TV. A selective approach to the management of gunshot wounds to the back. Am J Surg 1997; 174:342–346. Available from:
  14. Ogunlusi J D, Oginni L M, Ikem I C, Olasinde A A, Hamilton O G, Akinbolagbe A M et M Temitope. Gunshot Injuries in a Nigerian Hospital. Nigerian J Ortho and Trauma 2006; 5(2):34–37.
  15. Itodo C E, Williams T Y, Chukwukadibia N A, Ndubuisi C, David O O, Daniel D M. The Pattern of Civilian Gunshot Injuries at a University Hospital in North Central Nigeria. Journal of Dental and Medical Sciences 2015;14(2):87-90.
  16. Ogunlusi J D, Oginni L M. Death from Celebratory Gunshot Injuries. Internet Journal of Surgery 2005; 8 (1):1-3. Available from:
  17. Renz B M, Feliciano D V. Unnecessary laparotomies for trauma: A prospective study of morbidity. J Trauma 1995; 38:350–356. Available from:
  18. Hasaniya N, Demetriades D, Stephens A, Dubrowskiz R, Berne TV. Early morbidity and mortality of nontherapeutic operations for penetrating trauma. Am Surg 1994; 60:744–747. Available from:
  19. Nance M L, Nance F C. Is it time we told the emperor about his clothes. J Trauma. 1996; 40:185–186.
  20. Thompson J S, Moore E E, Duzer-Moore S V, Moore J B, Galloway A C. The evolution of abdominal stab wound management. J Trauma 1980; 20:478–84. Available from: 
  21. Salim A, Velmahos G C. When to Operate on Abdominal Gunshot Wounds. Scondinavian Journal of Surg 2002; 91:62-66. Available from:
  22. Adeyinka A A, Yunusa T, Nonye E. Profile of Abdominal trauma in federal Teaching Hospital, Gombe, North-East, Nigeria: A cross sectional study. Intern J of Innovative Medicine and Health Science. 2015; 4:41-45.
  23. Ivatury R R, Nallathambi M N, Robergee R J, Rohman M, Stahl W. Penetrating thoracic injuries: in-field stabilisation vs. prompt transport. J Trauma 1987; 27:1066–73. Available from:
  24. Sasser S, Barghese M, Kellermann A, Lordmand JD. Pre hospital trauma care systems. Geneva. World Health Organization, 2005. Available from:
  25. Holder Y, Peden M, Krug E. Injury Surveillance Guidelines. Geneva: World Health Organization, 2001.
  26. Aliyu S, Ibrahim A G, Mohammed B S, Jatau J. Gunshot injuries in Maiduguri north eastern Nigeria. Int J of Applied Research 2016; 2(3):539-541.



About AMH

Annals of Medicine & Health (AMH) is a peer reviewed medical journal that established and published by a governmental medical faculty titled Thamar University Faculty of Medicine & Health Sciences (TUFMHS). 


Faculty of Medicine & Health Sciences AL-Mohafadhah St. Dhamar City - Yemen

P.O.Box: 87246

Tel Fax: +967 6 509 578

Tel No: +967 6 509 577


Copyright © 2019 Thamar University - Faculty of Medicine and Health Sciences - Annals of Medicine & Health . All Rights Reserved. | Developed By ProSite Yemen