Abdominal trauma in the Sudan conflict: A multicentre analysis of injury patterns, surgical management, and mortality predictors (May 2023 - January 2025).

Abstract

Armed conflicts impose a substantial burden of traumatic injuries, particularly in low-resource settings where health systems are already strained. Abdominal trauma is among the most common and life-threatening injuries in modern warfare, often requiring urgent surgical intervention. Despite the scale of the ongoing conflict in Sudan, there is a lack of empirical data describing the patterns, management, and outcomes of abdominal trauma in this setting. This retrospective observational study was conducted across major trauma centers in Omdurman, Al-Obeid, and Al-Fashir, Sudan, between May 2023 and January 2025. All patients presenting with abdominal trauma who met the inclusion criteria were included. Data were collected from medical records using a structured tool and analyzed descriptively. Categorical variables were summarized as frequencies and proportions, while continuous variables were reported as medians and interquartile ranges (IQRs). A total of 253 patients were included, with a median age of 26 years (IQR 19-35), and 23.3% were female. Most patients were civilians (86.6%) and from urban areas (86.2%). Penetrating trauma accounted for 92.5% of injuries, with bullet injuries being the most common mechanism (44.3%), followed by shell injuries (32.4%). The small bowel (48.2%) and colon (28.9%) were the most frequently injured organs. The majority of patients (85.5%) underwent surgical management, while 14.6% were managed conservatively. Blood transfusion was required in 65.2% of cases, and 8.7% were admitted to the intensive care unit. Among patients surviving beyond the first 24 h, the in-hospital mortality rate was 6.7%. Wound infection (12.6%), sepsis (5.5%), and shock (5.1%) were the most commonly reported complications. Among patients with conflict-related abdominal trauma who survived beyond the first 24 h of hospital admission, in-hospital mortality was observed in a minority of cases and was more frequent among patients presenting with early physiological instability and severe associated injuries. These findings highlight the importance of timely surgical care, early resuscitation, and adequate critical-care resources in improving outcomes. This study provides important descriptive evidence to support trauma system strengthening in conflict-affected, resource-limited settings.