Complex Multiorgan Penetrating Abdominal Trauma During Gaza conflict – A Case Report

Abstract

Penetrating abdominal trauma can be a complex challenge for clinicians and requires concurrent resuscitation and urgent decision-making, particularly in war settings with limited medical resources. We report the case of a 32-year-old female who sustained a penetrating abdominal injury during the Gaza conflict, resulting in severe intra-abdominal injuries, including a grade I liver capsular injury, near-complete gastric transection, Grade V splenic injury, left renal cortical laceration with active bleeding, and multiple large bowel injuries with complete laceration of the duodenojejunal junction. She arrived hemodynamically unstable with signs of peritonitis, necessitating an emergent laparotomy. A retained 6 cm tank machine gun bullet was identified behind the liver. Due to resource limitations, ICU admission and full damage control protocols were not feasible. Postoperative complications included delayed renal hemorrhage requiring embolization, which could not be performed due to lack of interventional radiology. Despite these challenges, the patient was stabilized and discharged. This case highlights the challenges of managing complex abdominal trauma in war zones, emphasizing the need for adaptability when standard trauma protocols cannot be applied.