Back ground: The abdomen is one of most commonly injured body part, necessitating surgery. Blunt and penetrating are the two main mechanisms of abdominal trauma. Stab and gunshot wound are major patterns in penetrating abdominal injuries. Morbidities and mortality of penetrating abdominal injuries is based on mechanism of injuries and patient’s condition. Objective: To assess patterns, associated factors and treatment outcomes of penetrating abdominal injury among patients seen at Tebebe Ghion specialized hospital and Felege Hiwot comprehensive specialized hospital from Jan.2019-Sep. 2022, Bahir Dar, Ethiopia. Methods: A retrospective crossectional hospital based study of patients operated with diagnosis of penetrating abdominal injuries. About 261 cases who meet inclusion criteria were selected by simple random techniques and included in the study. The collected data entered into Epi data 3.1 and exported to SPSS version 25 for analysis. A Binomial logistic regression model done to identify the associated factors. Variables with P-value < 0.25 in binary logistic regression analysis were a candidate for multi-variable analysis and P-value <0.05 in multi-variable analysis used to declare as statistically significant. The odds ratio (OR) with at 95% confidence interval (CI) used to measure the strength of association. Result: Among 261 operated cases males were predominant 219(83.9%) whereas females were only 42(16.1%). The mean age was 29 years (SD ± 13). The mechanism of injury was gunshot wounds in 166(63.6%) and stab injuries in 95(36.4%) cases. 204(78.2%) had hollow viscus injury, of which isolated small bowel, large bowel ,stomach ,and genitourinary injuries account 68(26.1%),53(20.0%),19(7.3%),and 9(3.4%)respectively. 59(22.6%) were diagnosed with solid organ injuries with 29(11.1) liver, 15(5.7%) spleen, 11(4.2%) kidney and 3(1.1) pancreatic injuries. Surgical site infection was the most common post-operative complication (16.9%), and mortality is 9.2%. Operative time, blood pressure at presentation and presence of solid organ injuries were significantly associated factors of mortality. Conclusion: Penetrating abdominal injury affects predominantly males between ages of 19-45 years. GSW is a major mechanism of injuries study found the length operative time, presentation with shock and presence of solid organ in penetrating abdominal injury were highly associated with mortality in penetrating abdominal injuries. Recommendation: We recommend to the hospital to enhance deliver of early intensive post-operative care decrease death of critically injured penetrating abdominal injury patients. We recommend the department of surgery to encourage abbreviating operative time in patients with hemodynamic instability as much as possible.