BACKGROUND: Currently, any surgeon can encounter a mine blast wound to the abdomen and must be prepared to provide qualified care. The nature of injuries in modern combat trauma has changed compared to previous military conflicts. Therefore, the principles of their diagnosis and treatment require clarification. aim: of this study was to analyze our clinical experience in providing medical care for patients with abdominal wounds sustained during a modern military conflict. Methods: This study evaluated the clinical management and outcomes of 231 patients with penetrating abdominal injuries sustained during combat operations. Native computed tomography was performed in all admitted casualties. Gastro-duodenoscopy and colonoscopy were carried out selectively, based on clinical indications. Depending on the severity of the patient’s condition, either a staged surgical approach or a single-stage surgical treatment was applied. Results: A total of 1,359 patients were initially suspected of having abdominal combat trauma. Following comprehensive diagnostic evaluation, internal organ injuries were excluded in 1,128 patients (83%). Laparotomy was performed in 224 patients (16.5%), laparoscopy—in 7 (0.5%). Isolated wounds were present in 40 (17.3%) wounded, combined—in 191 (82.7%). Penetrating abdominal trauma was combined with wounds to the chest, extremities, pelvis, head and spine. In 96 cases (41.5%), the participation of specialists of three or more surgical specialties was necessary. Patients sustaining small-fragment injuries often presented with an initially blurred clinical and instrumental picture during the first post-injury hours. Among penetrating abdominal wounds, only 5 cases (2.2 %) demonstrated no damage to underlying anatomical structures. In 98 (42.4%) cases, only minimal interventions were required, including suturing of hollow organ injuries and hemostasis with coagulation/suturing. There were no mortality rates in the immediate postoperative period. Conclusion: Penetrating abdominal wounds inflicted by modern fragmentation ordnance can be very difficult to recognize in the early stages. The best treatment outcomes can potentially be achieved only by bringing high-tech care closer to the scene of hostilities, early detection, and treatment of internal organ damage before peritonitis develops. If abdominal wounds are suspected, performing native CT scans on all patients and endoscopic examinations when indicated allows for a highly accurate diagnosis and selection of patients for whom laparotomy is indicated on an emergency basis. When choosing the extent of surgical intervention, it is important to consider the overall severity of the patient’s condition and remember that excessive surgical trauma will only harm the patient. Nevertheless, the application of a reduced-volume initial surgical intervention combined with a staged surgical management strategy is warranted only in selected cases of combat casualties. Strengthening collaboration between military and civilian healthcare systems and creating mechanisms for improved continuity of care are essential.