Management of Abdominal Trauma at Three Hospitals in the Western Cameroon

Abstract

Introduction: Abdominal trauma represents a major public health issue, particularly in low or middle-income countries. It is responsible for a high rate of morbidity and mortality due to bleeding from solid organs and peritonitis following perforation of hollow organs. The severity and evolution depend on the type of lesion, the delay in management, and the resources available. Despite the importance of the subject, data are scarce in semi-rural regions such as West Cameroon. The main objective of this study was to describe the diagnosis, management and prognostic aspects of abdominal trauma in the three reference hospitals of the semi-rural West Region of Cameroon. Methodology: This was a multicentre, descriptive and analytical study, combining retrospective (from 1st January 2020 to 31st December 2024) and prospective (from 1st January to 31st May 2025) data collection, carried out in three reference hospitals of the West Region. 258 patients admitted for abdominal trauma were included. For the analysis of prognostic factors, a case-control study (“82 complicated cases” versus “82 controls free from complications”) was conducted, in strict compliance with ethical procedures. Statistical analysis was performed using SPSS version 23. Results: we had a total of 3082 traumas with 282 abdominal traumas, giving a hospital prevalence of 9,15%. The incidence was 1,45 case per month per hospital. Our results concern 258 cases. . Males were significantly more prevalent, with 198/258 (76.7%) participants and a sex ratio of 3.3. The main causes were road traffic accidents with 153/258 cases (59.3%), domestic accidents (9.7%), falls from height (10.5%), sports accidents (4.7%), and workplace accidents 2/258 (0.7%). Diagnosis was mainly based on clinical examination and abdominal ultrasound (68%). Surgical intervention was necessary in 55% of cases. The spleen (47%), mesentery (25.6%), and liver (15%) are the most commonly affected solid organs, and the digestive tract (stomach, small intestine, colon) is the most commonly affected hollow organ (19.25%). The complication rate was 82/258 (31.78%). The most frequent immediate/early complications were peritonitis (24.4%) and hemorrhagic shock (13.4%). Short term complications (occurring in the following days) mainly included surgical site infections (15.8%), sepsis (9.7%), and digestive fistulas (8.6%). Late complications were rare: intestinal obstruction (3.8%) and short bowel syndrome (2.4%). After bivariate and then multivariate analysis, the five factors associated with complications were polytrauma ORa = 22.32; p = 0.019); hemoperitoneum > 1000 ml (ORa = 11.11; p = 0.024); open trauma (ORa = 5.54; p = 0.005); ASA score > I (ORa = 5.41; p = 0.033) and hemodynamic instability with shock index > 0.9 (ORa = 4.90; p = 0.003). The mortality rate was 15/258 (5.81%). Death was significantly associated with three factors: hemodynamic instability with a Shock Index (SI) > 0.9 (ORa = 6.25; p = 0.001), polytrauma with Injury Severity Score (ISS) above 16/75 (ORa = 4.12; p = 0.015) and ultrasound-detected hemoperitoneum ≥ 1000 mL (ORa = 3.58; p = 0.037). Conclusion: Abdominal trauma primarily affects young adults and is dominated by road-traffic accidents. Early recognition of severity factors and appropriate management are essential to improve prognosis in our semi-rural context. There is need for continuous staff training on non-operative management.