Laparoscopic Removal of Retained Bullet in Penetrating Retroperitoneal Gunshot Injury

Gunshot wounds (GSWs) to the abdomen often necessitate open surgical exploration due to the potential for critical visceral and vascular injuries. In hemodynamically stable patients without major intra-abdominal trauma, laparoscopy is increasingly being recognized as a viable diagnostic and therapeutic alternative. We report the case of a 38-year-old female who sustained a GSW to the right mid-back. On arrival, she was stable. Imaging revealed a bullet retained in the retroperitoneum at the L2 vertebral level, in proximity to the inferior vena cava, ureter, and third part of the duodenum. With no signs of visceral injury and minimal hemoperitoneum, the patient underwent successful laparoscopic bullet removal without complications. She was discharged on postoperative day 2 and had an uneventful recovery. In selected stable patients, minimally invasive techniques can be safely applied in the management of penetrating trauma. Retroperitoneal bullet retrieval via laparoscopy, although infrequently reported, can be safely accomplished with careful planning and expertise. Laparoscopic retrieval of bullets in retroperitoneal trauma is a feasible and safe option in carefully selected cases, with the added benefits of reduced postoperative complications and shorter hospital stay.