ABDOMINAL GUNSHOT WOUNDS DURING CIVILIAN VIOLENCE IN KASHMIR, A PROSPECTIVE STUDY.

Malik Suhail Ahmad; Azher Mushtaq; Mumtaz ud din Wani; Fahad ul Islam Mir.

Volume : VII, Issue : II, February - 2018

ABDOMINAL GUNSHOT WOUNDS DURING CIVILIAN VIOLENCE IN KASHMIR, A PROSPECTIVE STUDY.

Malik Suhail Ahmad, Azher Mushtaq, Mumtaz Ud Din Wani, Fahad Ul Islam Mir.

Abstract :

Background: In the present world, Violence is emerging as a major public health problem taking a heavy toll of human lives and is telling upon the health care of the communities.

Objectives: To assess the pattern and outcome of gunshot victims in our valley as a means to improve the existing health care infrastructure.

Methodology: The study was conducted in the department of surgery, Government medical college Srinagar during an episode of civil unrest in july 2016. The patients with bullet injuries to abdomen formed the part of our study. All the patients were assessed for age, sex, Clinical presentation, need for surgery, Intra–operative findings, outcome and postoperative course.

Observations: In a total of 356 injured patients received in the emergency department during the period of unrest.. 45 patients (12.64%) had bullet injuries, 7 patients(1.9%) were hit by tear gas shells and 304 patients(85.3%) were the victims of pellet injuries. Among the bullet hit patients 30 patients (66.67%) had bullet injury to the abdomen while as 15 patients (33.11%) had bullet injury to other parts of body like head and neck and extremities. The main cause of gunshot injuries in our region are the bullets fired by armed government personals on rioting mobs during episodes of civil unrest. The mean age of patients in our study was 26.5 ± 8.9 years. The most common presentation of abdominal bullet injuries in our study was peritonitis in 12/20 patients (60%) followed by shock in 6/20 patients (30%). 1 patient in our study had evisceration of small bowel through the exit wound 5/20 patients (25%) had associated hemothorax and 3/20 patients had associated pelvic fracture in our study. Majority of patients in our study , 10/20 patients (50%) had small bowel perforation. 2 patients had liver trauma, one among them had major hepatic vascular injury. 2 patients in our study had associated splenic injury, 3 patients had colonic perforation, 2 had diaphragmatic tear, 2 had pelvic fracture, 1 patient had verteal fracture and 1 had associated renal injury. Postoperatively, 12/20 patients in our study developed wound infection, 2/20 patients developed abdominal dehiscence and 2/20 patients developed septicaemia.

Conclusion: There is a strong need to provide all the major hospitals in this valley with well equipped trauma care facility centres so as to utilise the valuable time otherwise lost in transporting every such patient to a tertiary care hospital and a hospital based registry for reporting all such gunshot injuries with respect to the place of the incident and their outcome be maintained so as to assess both the magnitude of this violence as well as to serve as a measure to improve the health care infrastructure.