Laparoscopic removal of renal foreign body in an isolated gunshot penetrating abdominal wound (description of two clinical cases)

Abstract

Background. In wartime, kidney injuries are combined with damage to other organs. The standard of care for these injuries is immediate revision with subsequent organ-preserving surgery. But as of today, clear criteria for selecting such wounded people for surgical treatment have not been developed, renal morphological and functional changes due to gunshot wounds have not been studied. The aim is to demonstrate the possibilities of minimally invasive technologies in an isolated gunshot shrapnel penetrating abdominal wound with renal trauma and the presence of a foreign body (metal fragment) in the kidney. Materials and methods. Two soldiers were injured as a result of artillery shelling in August 2023. They were taken to the frontline surgical team 1 and 3 days after the injury, where they were examined according to the FAST protocol and bandaged. After 6 hours, they were taken to the Military Medical Clinical Center of the Eastern Region. Results. Wounded P., 48 years old, was admitted 3 days after the trauma. The patient’s general condition is stable, laboratory values are normal. The examination revealed an entrance wound in the lumbar region on the right, 20 mm in diame-ter, without signs of bleeding. According to multislice computed tomography, 12 × 7 mm metal fragment of the superior pole of the right kidney was detected. The severity of renal trauma was classified as grade 2 according to the American Association for the Surgery of Trauma classification. The fragment was removed from the kidney parenchyma using a magnetic instrument for endovideoscopic diagnosis and removal of metal ferromagnetic foreign bodies. The surgery duration was 95 minutes. The patient was discharged on day 4. Wounded S., 45 years old, was admitted one day after the injury. The patient’s general condition is stable. Laboratory tests showed mild anemia. Examination revealed an entrance wound in the left lumbar region with a diameter of 15 mm. According to the native multislice computed tomography, a metal fragment in the middle segment of the left kidney of 8 × 8 mm with a retroperitoneal hematoma of 111 × 30 × 68 mm was diagnosed. The severity of the kidney trauma was classified as grade 3. Laparoscopic removal of the metal fragment of the left kidney and drainage of the retroperitoneal hematoma were performed. The fragment was removed after drainage of the retroperitoneal hematoma and slight dilation of the entrance gunshot wound of the kidney using a magnetic instrument for endovideoscopic diagnosis and removal of metal ferromagnetic foreign bodies. The surgery lasted 125 minutes. The patient was discharged on day 6. Conclusions. Laparoscopic access can be used to remove metal fragments from isolated gunshot wounds of the kidney. The use of a modern surgical magnetic instrument is recommended for a minimally invasive approach and to ensure efficiency. Such surgical interventions are possible with the availability of equipment, trained personnel and can be postponed.

Keywords

• gunshot wound
• kidney injury
• minimally invasive technologies