Abdominal trauma in war.

In war, the percentage of casualties with abdominal wounds on battlefields is near 20%. Roughly half of these casualties die almost immediately from bleeding. Wounding agents are most often either bullets or fragments from various detonating devices. Severity of pathology induced by these agents and prolonged lag time between injury and treatment constitute major differences between peace and war abdominal injuries. Since the means of diagnosis is unsophisticated in war, penetrating abdominal injury leads to systematic exploratory laparotomy, although 10% to 20% of explorations are negative. The management of colon lesions remains a controversial issue. In modern war surgery manuals, primary colon repair is not totally condemned and is generally considered acceptable, but under stricter criteria than in civilian practice. In abdominal war wounds, mortality rate dropped from 53% during World War I to 18-36% at the end of World War II. In Vietnam it went down near 10% in some limited hospital series. But other data collected during that conflict show a less rosy picture. Of 476 abdominal casualties, the total mortality reached 42%. The hospital mortality among the survivors was 11.5%. Death in cases where abdominal wound was the primary lesion was due to hemorrhage in 60%, sepsis in 25%, and pulmonary insufficiency in 15%. Survivors had an average of 1.8 injured organs.