Background: Traumas are an important public health concern, and remain a growing problem in some countries including Ethiopia. Even though in Ethiopia abdominal trauma is among the leading causes of morbidity and mortality, few published studies have been conducted so far on the indication of laparotomy and treatment outcome. Objective: This study aimed to assess indication laparotomy for abdominal injury & outcome of patients at Tibebe Ghion Teaching Hospital (TGTH) and Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in Bahir Dar City, Northwest Ethiopia, 2021. Methods: Institution-based retrospective cross-sectional study was conducted adult patients who underwent laparotomy for abdominal injury conducted from January 1 2019 to August 30, 2021 at TGTH and FHCSH in Bahir Dar City. Secondary data were collected by reviewing patient charts using pre-tested checklists. Data were entered into the Epi data version 3.1and exported to SPSS version 23 for further analyses. Bi-variable and multivariable regressions were performed and adjusted odds ratio (AOR) with its 95% confidence intervals (CI) was estimated to identify the factors associated with the outcome of patient with abdominal injury who underwent laparotomy Result: A total of 160 patient charts were included in the study. The mean age was 31.96 ± 14.07 years (Mean ± SD) with a range of 5-73 years. Bullet or gunshot 65(58.0%) and road traffic accident 30(62.5%) were the main indication of laparotomy. The mortality rate after laparotomy were 17(10.6%, 95% CI: 6.3-15.6%). Systolic blood pressure <90mmHg (AOR= 24.17, 95% CI: 2.27-257.78), blood transfusion (AOR=22.42, 95% CI: 2.25-223.03) and penetrating abdominal trauma (AOR=19.05, 95% CI: 1.39-261.22) were significantly associated with the outcomes of laparotomy. Conclusion: The mortality rate among laparotomy underwent was high. Systolic blood pressure<90mmHg, penetrating trauma and blood transfusion were significantly associated with the outcome of laparotomy. Bullet or gunshot and RTA were main indication of laparotomy. Appropriate perioperative management of patients might improve the outcome of laparotomy. Keywords: Abdominal injury, trauma, Laparotomy, Indication 1. Introduction