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Abstract
RÉSUMÉ
Introduction. Les plaies abdominales par arme à feu (PAAF) constituent une urgence chirurgicale vitale, particulièrement dans les zones de conflit armé où les ressources médicales sont limitées. Au Burkina Faso, l'insécurité croissante expose les populations civiles et militaires à ces traumatismes sévères, dont la prise en charge reste mal documentée. Cette étude décrit les aspects épidémiologiques, diagnostiques, thérapeutiques et pronostiques des PAAF au Centre Hospitalier Régional Universitaire de Fada N'Gourma (CHRU-FG). Méthodes. Nous avons mené une étude rétrospective descriptive et analytique du 25 décembre 2024 au 24 décembre 2025, incluant tous les patients hospitalisés pour PAAF. Les données ont été extraites des dossiers médicaux et analysées avec SPSS 25. Les facteurs associés à la mortalité ont été identifiés par le test exact de Fisher et le test de Mann-Whitney (p<0,05). Résultats. Quarante et un cas de PAAF ont été recensés parmi 719 traumatismes balistiques (5,7%). L'âge moyen était de 28,3 ans, avec une prédominance masculine (90,2%). Les attaques de groupes armés (87,8%) et les civils (58,5%) prédominaient. Un choc hémorragique était présent chez 36,6% des patients. Les plaies étaient pénétrantes dans 68,3% des cas, avec des atteintes thoraciques associées (24,4%). Une laparotomie a été réalisée chez 70,7% des patients. Les lésions digestives étaient fréquentes (grêle et côlon : 24,4%). Une transfusion a été nécessaire chez 53,7% des patients. La mortalité globale était de 22%. Les facteurs associés au décès étaient l'instabilité hémodynamique, les lésions polyviscérales, la transfusion et les complications postopératoires. Conclusion. Les PAAF touchent principalement les jeunes adultes masculins, avec une mortalité élevée (22%) liée aux retards d'évacuation et aux lésions multiviscérales. L'amélioration de la prise en charge passe par le renforcement des capacités diagnostiques (TDM) et thérapeutiques (transfusion, damage control) des structures régionales.
ABSTRACT
Introduction. Abdominal gunshot wounds (AGSWs) are life-threatening surgical emergencies, particularly in armed conflict zones with limited medical resources. In Burkina Faso, increasing insecurity exposes civilians and military personnel to these severe traumas, yet their management remains poorly documented. This study aimed to describe the epidemiological, diagnostic, therapeutic, and prognostic aspects of AGSWs at the Fada N'Gourma University Regional Hospital (CHRU-FG). Methods. We conducted a retrospective descriptive and analytical study from December 25, 2024, to December 24, 2025, including all patients hospitalized for AGSWs. Data were extracted from medical records and analyzed with SPSS 25. Factors associated with mortality were identified using Fisher's exact test and the Mann-Whitney test (p<0.05). Results. Forty-one AGSW cases were identified among 719 ballistic traumas (5.7%). Mean age was 28.3 years, with a male predominance (90.2%). Armed group attacks (87.8%) and civilians (58.5%) predominated. Hemorrhagic shock was present in 36.6% of patients. Wounds were penetrating in 68.3% of cases, with associated thoracic injuries (24.4%). Laparotomy was performed in 70.7% of patients. Digestive lesions were frequent (small bowel and colon: 24.4%). Blood transfusion was needed in 53.7% of patients. Overall mortality was 22%. Factors associated with death were hemodynamic instability, multivisceral injuries, transfusion, and postoperative complications. Conclusion. AGSWs predominantly affect young adult males, with high mortality (22%) related to evacuation delays and multivisceral injuries. Improving outcomes requires strengthening diagnostic (CT) and therapeutic (transfusion, damage control) capacities of regional facilities.
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References
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- 14.Liu T, Fang X, Bai Z, Liu L, Lu H, Qi X. Outcomes of selective non-operative management in adults with abdominal gunshot wounds: a systematic review and meta-analysis. Int J Surg. 2024;110(2):1183‑95.
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- 16.Peponis T, Kasotakis G, Yu J, Alouidor R, Burkott B, Maung AA, et al. Selective Nonoperative Management of Abdominal Gunshot Wounds from Heresy to Adoption: A Multicenter Study of the Research Consortium of New England Centers for Trauma (ReCoNECT). J Am Coll Surg. 2017;224(6):1036‑45.
- 17.Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, et al. Practice Management Guidelines for Selective Nonoperative Management of Penetrating Abdominal Trauma. J Trauma Inj Infect Crit Care. 2010;68(3):721‑33.
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References
1.Diop A, Faye AC, Thamar MIDL, Ndiaye M, Diakhate C, Ba M, et al. Penetrating Abdominal Wounds: Epidemiological, Diagnostic and Therapeutic Aspects at Idrissa Pouye General Hospital in Dakar. Int J Surg Sci. 1 oct 2025;9(4):114‑8.
2.Issa Mapouka PA, Ngatchoukpo VN, Ngboko Mirotiga, PA, Nabia DR, Roméo Fioboy VA, Tékpa BJDD. Les Plaies Pénétrantes De L’abdomen Par Armes À Feu : Aspects Épidémiologiques, Cliniques, Lésionnels Et Thérapeutiques Au CHU Communautaire De Bangui, Centrafrique. Eur Sci J. 2019;15(36):475-88.
3.Endeshaw D, Delie AM, Adal O, Tareke AA, Bogale EK, Anagaw TF, et al. Mortality and its predictors in abdominal injury across sub-Saharan Africa: systematic review and meta-analysis. BMC Emerg Med. 2024;24(1):57.
4.Traoré B, Coulibaly P, Traoré D, Coulibaly M, Sagara S, Guindo O, et al. Management of Abdominal Gunshot Wounds of Ballistic Trauma at Somine DOLO Hospital of Mopti. Acta Sci Med Sci. 2022;6(5):115‑9.
5.G. L. Hermann B, Cyprien Z, Nassirou Y, Namori K, Roland SO, Gustave SB. Traumatismes de L’abdomen en Milieu Africain : Aspects Épidémiologiques, Diagnostiques, et Thérapeutiques. Eur Sci J. 2020;16(21):132-41.
6.Velmahos GC, Demetriades D, Toutouzas KG, Sarkisyan G, Chan LS, Ishak R, et al. Selective Nonoperative Management in 1,856 Patients With Abdominal Gunshot Wounds: Should Routine Laparotomy Still Be the Standard of Care?: Ann Surg. 2001;234(3):395‑403.
7.Reed BL, Patel NJ, McDonald AA, Baughman WC, Claridge JA, Como JJ. Selective nonoperative management of abdominal gunshot wounds with isolated solid organ injury. Midwest Surg Assoc. 2017;213(3):583‑5.
8.Bonko NM, Badawy M, Nchifor K, Mumba M, Omboga L, Mugo R, et al. Outcome of gunshot abdominal injuries. Ann Afr Surg. 2020;17(1):30-4.
9.Qi J, Kong V, Ko J, Narayanan A, Wang J, Leow P, et al. Management of thoracoabdominal gunshot wounds – Experience from a major trauma centre in South Africa. Injury. 2024;55(1):e111186.
10.Obadiel YA, Albrashi A, Allahabi N, Sharafaddeen M, Ahmed F. Outcomes of Nonoperative Management of Penetrating Abdominal Trauma Injury: A Retrospective Study. Cureus. 2024;16(4):e58599.
11.Mbah N. Civilian Abdominal Gunshot Injuries at Awka, Nigeria. Vol. 7. 2024;7.
12.Lian T, Ashbrook M, Myers L, Chiba H, Ghafil C, Silverstein M, et al. Diagnostic accuracy of computed tomography findings for hollow viscus injuries following thoracoabdominal gunshot wounds. J Trauma Acute Care Surg. 2023;94(1):156‑61.
13.Vasquez M, Dhillon NK, Feliciano DV, Scalea TM. The fallacy of a roadmap computed tomography after an abdominal gunshot wound: A road that leads to nowhere. J Trauma Acute Care Surg. 2024;97(5):785‑90.
14.Liu T, Fang X, Bai Z, Liu L, Lu H, Qi X. Outcomes of selective non-operative management in adults with abdominal gunshot wounds: a systematic review and meta-analysis. Int J Surg. 2024;110(2):1183‑95.
15.Navsaria PH, Nicol AJ, Edu S, Gandhi R, Ball CG. Selective Nonoperative Management in 1106 Patients With Abdominal Gunshot Wounds: Conclusions on Safety, Efficacy, and the Role of Selective CT Imaging in a Prospective Single-center Study. Ann Surg. 2015;261(4):760‑4.
16.Peponis T, Kasotakis G, Yu J, Alouidor R, Burkott B, Maung AA, et al. Selective Nonoperative Management of Abdominal Gunshot Wounds from Heresy to Adoption: A Multicenter Study of the Research Consortium of New England Centers for Trauma (ReCoNECT). J Am Coll Surg. 2017;224(6):1036‑45.
17.Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, et al. Practice Management Guidelines for Selective Nonoperative Management of Penetrating Abdominal Trauma. J Trauma Inj Infect Crit Care. 2010;68(3):721‑33.
18.Haddadin Z, Hanna K, Gries LM, Zeeshan M, Tang A, Ditillo M, et al. Evolution of Nonoperative Management of Abdominal Gunshot Wounds in the US: Analysis of 16,866 Abdominal Gunshot Wounds. J Am Coll Surg. 2019;229(4, Suppl 1):S295.
