Abdominal trauma and laparotomy in wartime civilian and military casualties: A National Registry Study.

Authors

Sami Gendler, Elad Sarfaty, Tomer Talmy, Israel Trauma Group, Adi Givon, Ilan Schrier

Published in

Injury. Pages 113535. Jul 24, 2026. Epub Jul 24, 2026.

Abstract

Combat-related abdominal trauma remains a major challenge in modern warfare, typically resulting from high-energy penetrating injuries. Studying injury patterns provides insight into surgical decision-making. This study aimed to characterize abdominal trauma sustained during the conflict and identify predictors for laparotomy.
Retrospective nationwide cohort study was conducted using the Israeli National Trauma Registry. Patients with abdominal trauma between October 7, 2023, and May 31, 2024, during the Swords of Iron War were included and classified into laparotomy and non-laparotomy groups. Military and civilian casualties were compared. The primary outcome was mortality; secondary outcomes included ICU admission and rehabilitation discharge. A multivariable regression model was constructed to identify variables associated with the need for laparotomy.
Of 2422 trauma patients, 561 (23%) sustained abdominal injuries, and 140 (25%) underwent laparotomy. Compared with non-laparotomy patients, laparotomy patients had higher rates of penetrating trauma (92.1% vs 84.6%, p = 0.030), hypotension (16.2% vs 1.5%, p < 0.001), and Injury Severity Score >25 (46.4% vs 13%, p < 0.001). Mortality was higher in the laparotomy group (7.9% vs 2.4%, p = 0.007). Multivariable regression identified increasing injury severity, small bowel injury (OR 7.08, 95% CI 3.66-14.05), colon injury (OR 6.10, 95% CI 3.00-12.92), liver injury (OR 3.58, 95% CI 1.69-7.66), and retroperitoneal hemorrhage (OR 5.26, 95% CI 2.11-14.26) as independent variables associated with undergoing laparotomy. In univariable analyses among laparotomy patients, abdominal vascular injury was associated with mortality (OR 4.69, 95% CI 1.22-18.07), while ISS >=16 (OR 7.54, 95% CI 2.75-20.68), abdominal vascular injury (OR 11.81, 95% CI 1.52-91.59) and colonic injury (OR 2.49, 95% CI 1.17-5.31) were associated with ICU admission.
In this cohort of modern warfare casualties, abdominal trauma was common, and one-quarter of these patients required laparotomy. Despite high injury severity, in-hospital mortality remained relatively low. Small bowel, colonic, liver, and retroperitoneal injuries, together with increasing injury severity, were independently associated with the need for laparotomy. These findings underscore the surgical burden of abdominal trauma in conflict and may help guide triage and management in both military and civilian trauma systems.

PMID:
42521593
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

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