A 13-year-old Syrian boy was admitted in the emergency room with a bullet wound in the abdomen. Knowledge regarding the patient’s medical history was only that he was wounded in the abdomen and underwent surgery 24 h later. Details were not known.

When received in the hospital emergency room, the wounded Syrian boy was fully conscious; hemodynamics and respiration were stable, with signs of a gunshot wound to the right upper abdomen and signs of post laparotomy. Computer tomography revealed lack of a spleen (after splenectomy) and a small amount of free air. Another problem especially evident among the wounded Syrians is no imaging investigation or clinical examination, which can show and help us about their medical history, and because of that wounded Syrians need to go through a second laparotomy. The findings discovered after opening the abdomen were splenectomy, pancreatic tail resection, and bloody peritoneal fluid. Patient was stable throughout the surgery, and after surgery under anesthesia and on a respirator, and was transferred to intensive care for further therapy. In PICU after admission, the patient developed signs of shock (tachycardia, hypotension, and decreased urine output). Each patient transferred from Syrian territories to Israel was taken for culture and given antibiotics according to the protocol and injury. An important detail to note, patients who come have had initial treatment in Syria, such as opening the abdomen, the introduction of drains, and catheterization. We give attention to these drains; catheters as a source of infection should be replaced as soon as possible. Most of the bacteria infecting wounded Syrians are resistant to antibiotics, which means that most wounded Syrians are kept in an isolation room. After stabilizing his condition, the disease process was usual, and after 2 weeks a second laparotomy was necessary because of fever.