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Woman, 30 y old, sustained a gunshot wound to the right upper quadrant. She was and remained hemodynamically normal in the emergency room.
At laparotomy, the bullet was found to have penetrated the anterior and posterior surfaces of the stomach. There was minimal intraperitoneal blood but there was a right retroduodenal haematoma. A medial visceral rotation was performed.
|Right medial visceral rotation|
The head of the pancreas was injured (without injury to the main pancreatic duct) and the inferior vena cava was injured just below the junction with the right renal vein. The infrarenal vena cava was controlled with a vascular clamp and cephalad control achieved with compression of the reno-caval junction. The bullet was found lying in retroperitoneal tissues between the IVC and right kidney.
Total intraoperative blood loss was 400ml, and she had no post-operative complications. Submitted by:Luis Pinheiro. Viseu, Portugal