Introduction: The widespread use of advanced laparoscopic techniques has increased the interest in utilizing laparoscopy in the trauma setting. Unlike diagnostic laparoscopy, therapeutic laparoscopy for penetrating abdominal trauma remains a controversial approach. We here in presenting a patient with abdominal gunshot wound who was managed laparoscopically with a positive outcome.

Presentation: A 27-year-old female presented to ED with a single GSW to right back/flank. Primary survey was within normal. Secondary survey showed RUQ tenderness and a bullet entry wound in right back/flank, no exit wound. The patient was resuscitated. FAST exam revealed small right perinephric fluid collection. CT scan showed a grade 3 right renal injury with perinephric hematoma with no active extravasation, segment 6 liver laceration, hemoperitoneum and bullet in subcutaneous tissue in RUQ.

Procedure: Operative strategies were to stop bleeding from liver injury, to rule out hepatic flexure and small bowel injury, and extract the bullet if possible. Diagnostic laparoscopy revealed hemoperitoneum from actively bleeding laceration of segment 6 of the liver. Hemostasis was achieved with combination of bipolar electrocautery and hemostatic agent. Mobilization of hepatic flexure and running the small bowel revealed no injury. The patient tolerated the procedure well and discharged home on POD# 2.

Conclusions: In selected hemodynamically stable patients with abdominal gunshot wound, laparoscopy is feasible and safe diagnostic and therapeutic modality. The use of preoperative imaging, adherence to the predetermined operative strategies will avoid unnecessary laparotomy and minimize the potentials of missed injuries.