Treatment outcomes of retained bullet injuries to thoracoabdominal area: Insights from a single-center experience from Yemen

Background: There is a scarcity in the literature on the management of retained bullet injuries (RBIs), and there are no comprehensive treatment guidelines. This study reports a single-center experience in the management of thoracoabdominal RBIs in resource-limited settings. Patients and Methods: A retrospective study of 103 patients diagnosed with RBIs was conducted between January 2004 and December 2020 at Al-Nasar Hospital in Ibb, Yemen. Clinical demographic data, RBI occurrence and settings, injury characteristics, management, and outcomes were collected and analyzed. Results: The mean age was 36.0 ± 16.2 years, and most cases (75.7%) were men. Most RBIs occurred during wedding ceremonies (52.4%), while 37 (35.9%) occurred during war and political rallies, and 12 (11.7%) occurred during usual times. RBIs during wedding ceremonies were statistically significant compared with other injury times ( p < 0.001). Among the victims, 42.7% were unaware of the injury. The chest wall was the most common site of RBIs ( n = 42, 40.8%), followed by the thoracoabdominal area in 28 (27.2%) cases and the back in 15 (14.6%) cases. All patients underwent surgical exploration except for four (3.9%) cases, and chest tube insertion was the most common procedure ( n = 42, 40.8%). Four patients (3.9%) were permanently disabled, while nine (8.7%) died in the hospital during or after surgery. Mortality rates were significantly associated with time to hospital arrival, with longer delays resulting in death ( p < 0.001). Conclusion: In this study, RBIs primarily affected adult men during wedding ceremonies, with chest wall injuries being the most common and chest tube insertion being the most common procedure. Mortality rates were higher with delayed hospital admissions. Strategies of prevention initiatives should focus on raising awareness, vigilant law enforcement, and improving prehospital care.