Laparoscopic exploration of the retroperitoneum in a gunshot victim: A case report

Non-operative management and minimally invasive surgery reduce the burden of negative laparotomies in patients with penetrating gunshot wounds (GSW). Careful patient selection is key. Although challenging, in experienced hands laparoscopic exploration of the retroperitoneal space can be carried out.

A 38year old man was brought to the emergency room after sustaining a GSW to his right groin. Due to evidence of intoxication, clinical picture was unreliable, although the patient was hemodynamically stable and there were no signs of peritonitis. Furthermore, the presence of retained bullet fragments created significant artifact on imaging. Clinical and radiological uncertainty urged us to proceed with laparoscopic exploration. Following mobilization, the ascending colon wall was fully inspected and no injury was identified. The pelvic fracture was managed non-operatively. After an uneventful hospital course, the patient was discharged home in stable condition and outpatient follow up was re-assuring.

Avoiding morbidity from missed colonic injury is important, particularly in patients with unclear clinical and radiological findings, that were present in our case. Non-operative management by serial examination and minimally invasive surgical techniques are considered an alternative to the classical exploratory laparotomy approach. Furthermore, utilization of laparoscopy in retroperitoneal injury has gained much attention in the recent years particularly in well-established centers.

Laparoscopic exploration is a safe and effective surgical approach in patients who have sustained GSW to the abdomen and to the retroperitoneal space. However, it requires careful patient selection and surgical expertise.