Abdominal injuries are increasingly reported in both developed and developing countries and continue to be a major source of morbidity and mortality.1,2 The abdomen ranks third among the most commonly injured anatomical regions in trauma patients.2 Abdominal trauma can be classified as either blunt or penetrating. Although blunt abdominal trauma (BAT) is more frequently encountered, penetrating abdominal trauma (PAT) remains a critical component of emergency surgical practice.3 Blunt injuries account for approximately 90% of abdominal trauma cases.4 These injuries are often seen in the context of polytrauma, where abdominal injuries are associated with other systemic trauma, necessitating a comprehensive clinical evaluation to reduce the risk of overlooked injuries and additional complications.5

High-speed road traffic accidents, the increasing pace of modernization, violent crimes, terrorist activities, and sports-related incidents are some of the key contributing factors to the rising incidence of abdominal trauma. These high-energy impacts can lead to injuries involving multiple organs and systems, making the evaluation and management of abdominal trauma particularly challenging. A surgeon dealing with such cases must assess both parietal and visceral injuries, with the latter being either intraperitoneal or retroperitoneal. Commonly affected visceral organs include the liver, spleen, stomach, small and large intestines, duodenum, pancreas, kidneys, ureters, and retroperitoneal vasculature.6-8

Delays in hospital presentation, the complexity of managing multiple organ injuries, significant blood loss, and the inherent risk of high morbidity and mortality further complicate the clinical scenario. Despite abdominal trauma contributing substantially to trauma-related deaths and disabilities particularly in low- and middle-income countries there remains limited focus on structured interventions and optimized management protocols for these patients. Prompt diagnosis, timely surgical intervention, and diligent postoperative care are vital for improving outcomes.9 Therefore, this study aims to evaluate the clinical profile, intra-operative findings, follow-up status, and management outcomes of patients presenting with abdominal trauma at a tertiary care hospital.

A prospective observational study was conducted in the Department of General Surgery at a tertiary care hospital over a period of one year. The data was collected by direct interview with the patient or patient relatives accompanying the patient and obtaining a detailed history. All the patients with suspected abdominal injury were examined thoroughly, and baseline findings were recorded. Investigations: All the protocol investigations were done in every case, i.e. Abdominal Xray, CT scan, USG, Complete blood count, LFT, KFT etc., were done. Thorough assessments for injuries and initial resuscitation of the patients were done. Documentation of patients, related to clinical findings and demographic information, treatment procedures were recorded on a specially prepared Detailed history regarding the site of trauma, nature of object assaulted the patient was inquired.

Statistical Analysis

The data was primarily gathered in the form a structured proforma and details were entered in excel sheet. Categorical variables were summarized using frequency and percentages. Continuous variables were summarized using means and standard deviations (SD).

A total of 101 patients presenting with abdominal trauma were included in the study. Among 101 cases, blunt trauma was observed in 55 patients (54.45%), while penetrating trauma accounted for 46 patients (45.54%). The majority of cases were in the 21–30 years age group for both trauma types. Males were predominantly affected, especially in penetrating trauma (43 males) compared to females (3 females). Overall, abdominal trauma was more common in young adult males, (Table 1).

 Table 1: Distribution of study cases according to demographic data (n=101)

Pain was the most common symptom in both blunt (37 cases) and penetrating trauma (12 cases). Vomiting, distension, and hypotension were more frequently observed in blunt trauma. Hematuria and urinary retention were seen exclusively or more commonly in blunt trauma, with retention of urine reported only in blunt cases (7 patients). Overall, blunt trauma was associated with a broader and more severe symptom profile, (Figure 1).

Among patients undergoing surgery, exploratory laparotomy was the most common procedure, particularly in penetrating trauma cases (27 out of 46). Blunt trauma cases had fewer surgical interventions (19 out of 55), with general exploratory laparotomy being most frequent. Organ-specific procedures and perforation repair were performed in both groups, while minor procedures like ICD insertion and local wound care were exclusive to penetrating trauma, (Table 2).

Table 2: Showing distribution of study cases according to name of the surgery

Note: *Organ procedures include Hepatic lobectomy; Splenectomy; Splenorrhaphy; Cholecystectomy; Resection anastomosis; Resection anastomosis with colostomy)

Midline incision was commonly used in both blunt (19 cases) and penetrating trauma (36 cases). Bowel injuries and hemoperitoneum were more frequent in penetrating trauma (15 and 13 cases respectively) than in blunt trauma (6 and 9 cases). Solid organ injuries were slightly more common in blunt trauma (9 cases). Stomach perforations and peritoneal breaches were observed mainly in penetrating trauma. Ultrasound findings showed minimal fluid or bowel changes in most blunt trauma cases. Bilateral drains were more frequently inserted in penetrating trauma, while ICD use was exclusive to penetrating injuries, (Table 3).

Table 3: Showing distribution of study cases according to intra-op findings

Notes:

• Bowel injuries included multiple ileal, jejunal, and colonic perforations of varying sizes and locations. Details were combined for clarity.
• Solid organ injuries include liver lacerations, splenic lacerations, and pancreatic trauma (grouped by organ, not repeated).
• USG findings are summarized to avoid repetition (e.g., multiple reports of minimal interbowel fluid were collapsed).
• Hemoperitoneum volumes are summarized under ranges instead of repeating each volume value.
• Where specific structures had overlapping findings (e.g., serosal tears + perforation), only the major pathology is listed.

On postoperative Day 0, most patients had abdominal tenderness, either localized or diffuse, with a wide abdominal girth range (21.5"–40") and variable drain and urine outputs. The majority were managed with NBM, IV fluids, and antibiotics. By Day 3, improvement was noted in abdominal findings, with most patients showing soft, non-tender abdomens and stable outputs. On subsequent follow-up, 15 patients had soft, non-tender abdomens and continued uneventful recovery, indicating progressive post-operative improvement in blunt trauma patients, (Table 4).

Table 4: Distribution of study cases according to follow-up (Blunt Trauma)

On Day 0, most patients showed localized tenderness at the operative or wound site. Abdominal girth ranged from 23.5" to 42", with variable drain output (up to 300 mL), and urine output recorded in 32 cases (range: 400–4000 mL). Nearly all patients were managed conservatively with NBM, IV fluids, and antibiotics. By Day 3, tenderness at the operative site remained the most common finding. Drain output increased in some cases (up to 550 mL), but overall abdominal and urine output parameters indicated stabilization. Most patients continued to recover uneventfully. On Day 7, the majority had soft, non-tender abdomens, minimal or no drain output, and stable fluid balance, indicating significant clinical improvement and uneventful recovery in penetrating trauma cases, (Table 5).

Table 5: Distribution of study cases according to follow-up (Penetrating Trauma)

Both trauma groups had minimal co-morbidities, with one case each of USP++ and one Hepatitis B (only in blunt trauma). Blood transfusions were more frequent in blunt trauma, especially whole blood and platelets. PCV and FFP were used in both groups, often in combination. ICU admissions were slightly higher in penetrating trauma, with longer stays and more patients needing critical care (including ventilatory support in one patient from each group). At discharge, most patients recovered well, with 54 (53.46%) blunt and 42 (41.58%) penetrating trauma patients discharged healthy. Blunt trauma cases more commonly had shorter hospital stays (1–5 days), whereas penetrating trauma showed a trend toward longer hospital stays (6–15+ days), (Table 6).

Table 6: Management Outcomes in Blunt and Penetrating Trauma Patients

Common combinations administered: Whole Blood + FFP; PCV alone or with FFP; Whole Blood + PCV + FFP; Whole Blood + PCV + FFP + Platelets

In the present study, out of 101 patients, blunt abdominal trauma was slightly more common (54.45%) than penetrating abdominal trauma (45.54%). This is consistent with the findings of Aasole AG et al.9 and Ranjan SK et al.10, who reported higher frequencies of blunt trauma, typically due to road traffic accidents and falls, in contrast to penetrating injuries, which are often associated with stab wounds or gunshots. The incidence of abdominal trauma was common in the age group of 21-30 years in both types of injuries, i.e. in blunt, it was (17.82%) while in penetrating it was (19.80%). Musau P et al.11 reported 53.8% of abdominal trauma cases belonged to the 21-30 years age group. Whereas Kala S. et al.12 has reported 28% of cases in 21-30 years. Haque MA et al.13 have reported 29.9% of abdominal trauma cases in the age group of 11-20 years. In the majority of the studies, the most commonly involved age group was 21-30 years. In the current study, amongst male abdominal trauma was more common in comparison with a female which is comparable with the study done by Aasole AG et al.9, Musau P et al.11 and Gholipour S et al.14 The gender discrepancy with males outnumbering females seen in our study because males are the earning members of the family and are most exposed to outdoor activities in contrast to females, who tend to stay a home engaged in household activities.

In terms of clinical presentation, abdominal pain was the most common symptom across both trauma types, consistent with the observations by Aasole AG et al.9. Symptoms like vomiting, distension, hypotension, hematuria, and urinary retention were more pronounced in blunt trauma cases, indicating a broader and more severe symptom spectrum. These findings are in agreement with Aasole AG et al.9, who reported similar symptomatology in blunt trauma due to multi-organ involvement and internal bleeding.

Regarding management, present study noted that the majority of blunt trauma cases (65.45%) were managed conservatively, whereas 80.43% of penetrating injuries required surgical intervention, primarily exploratory laparotomy. Similar findings are reported by Aasole AG et al.9 and Demetriades D et al.15 who emphasized the need for operative management in penetrating injuries due to a higher incidence of hollow viscus and vascular injuries.

Intra-operative findings revealed that bowel injuries and hemoperitoneum were more common in penetrating trauma, while solid organ injuries such as liver and spleen lacerations were slightly more common in blunt trauma. This parallels the study by Chalya et al.16, which reported bowel perforations as a frequent finding in penetrating injuries and splenic/liver injuries in blunt cases. Our exclusive use of ICD insertion in penetrating trauma cases is also supported by studies that recommend aggressive drainage in contaminated penetrating wounds.

Postoperative progress and follow-up indicated uneventful recoveries in most cases from both groups, with softer abdominal findings and reduced drain output by Day 7, similar to findings reported by Talwar et al.17, suggesting the effectiveness of standardized post-op protocols. The use of NBM, IV fluids, and broad-spectrum antibiotics in the early postoperative period reflects standard care practices also supported by ATLS guidelines. ICU admissions, though slightly higher in penetrating trauma, were required in a minority, with both trauma groups having low rates of critical care interventions. One patient from each group required ventilatory support, highlighting the occasional severity of abdominal trauma. Hospital stay duration varied, with blunt trauma cases having shorter stays (1–5 days) and penetrating trauma patients often staying longer (6–15+ days). This trend has been similarly reported in studies by Nielsen JW et al.18, underscoring the increased complexity and resource use associated with penetrating injuries. Finally, our outcome analysis showed that most patients were discharged healthy, with an overall good prognosis. Discharge rates of 53.46% for blunt trauma and 41.58% for penetrating trauma were comparable to recovery rates in similar hospital-based studies, reinforcing the efficacy of timely and appropriate trauma management in tertiary care settings.19

Abdominal trauma remains a significant clinical concern, with blunt abdominal trauma being slightly more prevalent than penetrating abdominal trauma. Young adult males were predominantly affected in both types, reflecting socio-behavioral exposure to high-risk situations. While blunt trauma often presented with a broader spectrum of symptoms and was largely managed conservatively, penetrating trauma cases more frequently required surgical intervention due to the nature and extent of internal injuries. Exploratory laparotomy was the most commonly performed operative procedure, especially in PAT cases. Bowel injuries, hemoperitoneum, and stomach perforations were more commonly observed in penetrating trauma, while solid organ injuries were slightly more associated with blunt trauma. The majority of patients, in both groups, showed significant clinical improvement by postoperative Day 7, and most were discharged without major complications.

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