Laparoscopic exploration for a thoracoabdominal gunshot wound and retrieval of a wandering bullet: a case report

Introduction and importance:Penetrating gunshot wounds are a common surgical emergency. Historically, exploratory laparotomy was the standard treatment for all cases. However, due to the high rates of postoperative complications and unnecessary laparotomies, along with advancements in imaging techniques, more conservative approaches have been introduced for selected cases. Diagnostic and therapeutic laparoscopy is emerging as a safe alternative for a wider range of cases. Case presentation:A young male victim of a thoracoabdominal gunshot underwent a successful diagnostic laparoscopy procedure. Intraoperative findings revealed a nonbleeding liver injury that did not require any intervention. A wandering intraperitoneal bullet was also extracted. Clinical discussion:Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma is a safe and valid alternative for hemodynamically stable patients. It is particularly beneficial for diagnosing and treating diaphragmatic and mesenteric injuries, which are often missed by conventional imaging studies. Laparoscopy also offers advantages such as earlier recovery, shorter hospital stays, and improved cosmetic outcomes. Conclusion:Diagnostic and therapeutic laparoscopy is a safe and effective option for cases of penetrating abdominal trauma, with good outcomes expected when patients are carefully selected and experienced surgeons and resources are available. It is especially beneficial in equivocal cases where a definitive diagnosis cannot be made clinically or radiologically, reducing the need for exploratory laparotomies and their associated unpleasant consequences.