May 15, 2008 Al Yarmouk Teaching Hospital in Baghdad is one of Iraq's most well-known trauma centers; it is frequently mentioned in U.S. news reports from Baghdad. Fighting in Iraq has produced many civilian casualties causing doctors there to treat an unusually high proportion of civilian – as opposed to combatant – injuries.
Two urologists from Al Yarmouk Teaching Hospital have described their experience with the management of bladder injury in civilians with major abdominal trauma.
The most common cause of bladder trauma in the United States is blunt force, usually due to automobile accidents. Currently, the most common causes of civilian bladder trauma in Iraq are penetrating injuries from bullets or metallic fragments created by improvised explosive devices (IEDs).
From January 2005 to August 2006, the Emergency Department at Al Yarmouk Teaching Hospital received alive 533 patients with major abdominal trauma. Penetrating bladder injuries occurred in 12 percent of these cases. The majority of the patients were injured by bullets (78.1 percent) while the others were injured by shells or shrapnel from IEDs. Associated bowel injury was present in the great majority of patients (89 percent). The majority of injuries were severe and highly associated with other organ injuries. When abdominal injury was associated with chest and/or vascular trauma, there was a significantly higher mortality rate.
“Different wars in history have produced unique types of trauma,” said Ira D. Sharlip, M.D., a spokesman for the AUA. “The wartime medical experience in Iraq is unusual in having created such a large number of civilian injuries for civilian doctors to treat with limited facilities and equipment. “
Despite finding that 54.7 percent of the abdominal injuries were stage IV (advanced in the staging system of the American Association for the Surgery of Trauma), serious long-term complications occurred in only 10.9 percent of cases. A large majority (76.6 percent) were discharged alive and almost all of the bladder trauma cases recovered normal bladder function.
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- Alsaigh NK, Petros FG, Dhabi AA: Penetrating Bladder Injuries in Abdominal Trauma: An Experience from Iraq. J Urol, suppl., 2008; 179: 21, abstract 62. [link]
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