Madam,

This is in response to an article published in your journal’. The increase in number of patients with abdominal trauma after a 10 year period (from 248 to 327 in a 3 year period) could very well be explained by the rapid increase in population of Lahore and its surround­ing area. What is surprising is that with the concomitant increase in the number of vehicles and number of miles travelled per person per day there is actual decrease in the percentage of blunt trauma (15% to 13%) and minimal increase of 4 patients in actual number in 10 years. Although I don’t have the actual figures but my personal observation is that there is a marked increase in blunt trauma to abdomen during the last 10 years. With the increase in the frequency in the fire arm injuries (from 21% to 48%) and decrease in the actual number of stab wounds (64% to 39%) the morbidity and mortality is bound to increase. The mortality in liver injury is mainly dependent on the severity of the associated multiple injuries2. The doubling in mortality from 10.8% to 20.5% reflects doubling in frequency of fire arm injuries and increase in associated injuries from 44% to 66%. I give full points to the present day surgeons who are coping well with the increase in number of patients with almost little or no increase in facilities available. I was associated with the author in the same department for 5 years. I collected 297 cases of stab abdomen over a period of 7 years from 1 out of 4 surgical units (roughly 42 per year). Later on I worked in 5 surgical units in 2 years in a region in UK almost equal in population to Lahore. I saw not a single case of fire arm injury and only one minor case of stab abdomen during this period. This is a sad reflection of how violent our society is.

Azam Yusuf
Department of Surgery, Rawalpindi Medical college, Rawalpindi.

1. Ahmed, I. changing trends in abdominal trauma in a teaching hospital of Lahore. J.Pak.Med.Assoc., 1993;43:71­.
2. Schweizer, W., 1-luber, A., Blimgart, LH. Liver injury. Surgery, 1988;62:1471-76.