Anatomical patterns and factors associated with traumatic bowel injury among patients undergoing emergency surgery for abdominal trauma at two teaching hospitals in Uganda.

BACKGROUND: Bowel injuries represent a growing burden in blunt and penetrating abdominal and it is associated with poor outcome especially in developing countries. However, the anatomical patterns and factors associated are not well understood in the mentioned settings. This study aimed to determine the anatomical patterns and factors associated with traumatic bowel injury among patients undergoing surgery for abdominal trauma at Kampala international University teaching hospital (KIU-TH) and Fort Portal Regional Referral Hospital (FRRH). METHODS: This was a prospective observational study where consecutive sampling was used to select 99 patients of all ages admitted in surgical wards at KIUTH and FRRH with abdominal trauma and undergoing laparotomy during the study period that consented from 30th September to 30th December 2024. During laparotomy, it was confirmed whether there was bowel injury or not and then injury identified was repaired. Analysis was done using STATA version 16. Variables with a p value < 0.05 were considered significant. RESULTS: This study enrolled 99 study participants with abdominal trauma, and 34 of them had bowel injury. The most common part of the bowel injured was the small bowel (76.5%), specifically the jejunum (43.3%). The most frequently performed surgery was primary repair (58.7%). In the multivariate analysis, penetrative trauma (aOR: 3.62, p = 0.048) significantly increased the odds of bowel injury. Complications were significantly higher in the bowel injury group (30.6%) compared to those without (12.0%). Two deaths occurred during the study: one patient with bowel injury succumbed to complications of peritonitis and septic shock, while another death occurred in the non-bowel injury group due to liver laceration. CONCLUSION: Bowel injury is prevalent in penetrating abdominal trauma and is frequently associated with severe complications such as septic and hypovolemic shock. Strengthening paramedical services and ATLS training is essential to improve hemodynamic stability on arrival and reduce mortality.