Plaies pénétrantes de l'abdomen en pratique de guerre. Expérience de Bissau à propos de 20 cas

The authors relate in a descriptive and retrospective study their experience of perforating wounds of abdomen in war's practice about 20 cases out of 544 wounded persons, All the patients were males soldiers in their 18 to 41 years old with the average age of 27 years old. All of them have been treated within the emergency medical unit opened out in Bissau during Gabou operative from June 1998 to March 1999. The prevalent vulnerant agent was RPG7 splinters. The medical cares picking up and the evacuations have been performed in short delays of 25 minutes on an average (17 to 35 mn). The deployment of the health chain in this armed urban and suburban conflict had been set up in two (2) levels. The first aid post advanced was in the forward zone, 2 to 3 km from the fights line, and 7 to 8 km from the base of advanced surgical unit established in the backward zone. The taking care of the wounded persons at the arrival was ensured by a resuscitator doctor. Nineteen (19) wounded persons have been operated on within the first hour after their admission. Only three (3) patients had a surgical operation in the 5 th , 6 th , and 21 st hour. In conditions of delicate situation we have executed 21 laparotomies which have discovered 19 small intestine wounds and 3 associated colic wounds. We have noticed visceral injuries by multiples riddlings associated to the thorax injuries out of 4 cases, to the limbs injuries out of one case and to the soft parts injuries in all the cases, All these injuries have been treated in one time, Our main difficulties lied in the secondary evacuations to the backward base to Dakar, We have had 16 good results (80 %), 2 infections complications and 2 death. The case fatality rate was 10 %. We believe that the improvement of results of the perforating wounds of abdomen in war's practice passes by the precocity of the treatment. The ideal treatment in one time of colic injuries in difficult conditions of practice in Africa has seemed to us beneficial.