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. 2014;5(2):70-2.
doi: 10.1016/j.ijscr.2013.12.020. Epub 2013 Dec 24.

Adrenal gunshot wound: Laparoscopic approach. Report of a case

Antonino Agrusa  1 , Giorgio Romano  2 , Giovanni De Vita  2 , Giuseppe Frazzetta  2 , Daniela Chianetta  2 , Giuseppe Di Buono  2 , Gaspare Gulotta  2
Affiliations

Adrenal gunshot wound: Laparoscopic approach. Report of a case

Antonino Agrusa et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating abdominal injury, it is also clear that certain stable patients may be managed without operation. Controversy persists regarding use of laparoscopy.

Presentation of case: We report a case of gunshot wounds with bullet in left adrenal gland and perirenal subcapsular hematoma. The patients had no signs of peritonitis but in the observation period we noted a significative blood loss, so we performed an exploratory laparoscopy.

Discussion: We found the bullet in adrenal parenchyma. The postoperative period was regular and the patient was discharged without any local or general complication.

Conclusion: Although the data are still controversial, the importance of the laparoscopic approach is rapidly increasing also in case of penetrating trauma of the abdomen. This technique assumes both a diagnostic and therapeutic role by reducing the number of negative laparotomies.

Keywords: Gunshot wounds; Laparoscopy; Penetrating abdominal trauma.

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Figures

Fig. 1
Fig. 1
Penetrating wound in left lumbar region. Patient on surgical table.
Fig. 2
Fig. 2
CT scan of abdomen: left renal space with metallic foreign body.
Fig. 3
Fig. 3
(a) Intraoperative radiological control with an image intensifier. (b) Laparoscopic vision with extraction of the bullet out of the adrenal parenchyma.
See this image and copyright information in PMC

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