A healthy 40-year-old man arrived to the ER with a gunshot wound to the abdomen. On his arrival he was conscient but extremely agitated. His BP was 130/90 mmHg, HR, 120 beats/min. He had abdominal pain and an E-Fast positive for fluid in his abdomen. He couldn´t move his legs. On exposition, he was found to have a transabdominal wound from his left hypochondrium through his right back, at the level of T9. We activated the massive transfusion protocol and transfer the patient directly to the OR. We performed a median laparotomy and found 1000cc of hemoperitoneum, a zone I and left Zone II retroperitoneum hematoma, and a Grade III gastric injury in the anterior and posterior aspect of his stomach with minor contamination. We repaired the gastric injuries and proceeded to explore the retroperitoneal hematoma. At exploration, we found a left non-expanding perirenal hematoma, which we didn´t further explore. We also found a Grade III pancreatic injury just in the middle of the body of the pancreas. We performed a distal pancreatectomy with a stapler along with spleen preservation as we identified a preserved splenic vein. We packed the retroperitoneum with lap-pads. We furthermore placed a negative pressure wound temporary device over his abdomen and transferred the patient to the ICU for post-op resuscitation. We took the patient 3 more times to the OR to manage a small pancreatic fistula. After 9 days of stay the abdomen was closed and the patient was discharged without further complications