Laparoscopy is a minimally invasive surgical technique that has gained favor in many trauma centers for diagnostic and therapeutic purposes in trauma patients. Laparoscopy plays a particularly important role in penetrating injury for its ability to rule out penetration of the peritoneal cavity. Laparoscopy also allows for inspection of the diaphragm, evaluation of hepatic and splenic lacerations, and inspection of hollow viscus organs. In blunt trauma, CT scan has long been the diagnostic method of choice. However, CT scan cannot definitively rule out hollow viscus injury. Clinical examination can also be difficult in those patients who have an associated pelvic fracture and already have abdominal tenderness, or have a spinal cord injury and cannot report pain symptoms. Thus, laparoscopy allows for early definitive diagnosis and occasionally treatment as well. Currently, the role of laparoscopy in trauma is strictly limited to hemodynamically stable patients. Hemodynamically unstable, critical patients require a streamlined, rapid approach in obtaining a diagnosis and providing treatment. Any delay can potentially compromise the patient's care.

We present a case of an 18 year-old male who sustained a single stab wound to the right upper quadrant. On presentation to the trauma bay, the patient was hemodynamically stable but had diffuse peritoneal signs. No diagnostic studies were performed and the patient was taken directly to the operating room for exploratory laparoscopy. At laparoscopy, a through-and-through injury to the liver and the gall bladder was identified. Hemostasis was achieved from the liver injury using electrocautery, and a laparoscopic cholecystectomy was performed. The tract of the stab wound extended into the retroperitoneum. The duodenum was extensively kocherized and was found to be uninjured. The patient recovered uneventfully and was discharged home on post-operative day 2.