Experience of surgical treatment of a patient with severe combined pelvic abdominal gunshot wound and left kidney dystopia

An important trend in recent armed conflicts and terrorist attacks is the widespread use of explosive ammunition, which is accompanied by the impact of damaging elements with high kinetic energy on the body of the victims. Therefore, the distinctive features of modern abdominal gunshot trauma are the combined nature and severe multi-organ damage, requiring intensive care and specialized surgical care in the shortest possible time. The key to its successful implementation is preoperative diagnostics of injuries. An adequate assessment of their localization and nature allows to develop an operation plan and thereby minimize the risks of “surgical surprises”, and, if necessary, include specialists of the appropriate profile in the team. However, solving this problem is associated with significant difficulties due to the lack of time, as well as multiple injuries to internal organs. In addition, problems may be due to anomalies in their development, which significantly complicate the assessment of the topographic features of abdominal gunshot trauma. The article presents the experience of providing specialized surgical care for severe combined pelvic abdominal injury and a rare anatomical anomaly – pelvic dystopia of the left kidney. It is demonstrated that a comprehensive preoperative examination using CT imaging, along with timely planning of stages of the surgical intervention, provides good treatment results for this difficult category of patients, allowing to preserve the organ compromised by injury and developmental anomaly.

1. Alisov P. G., Samohvalov I. M. Gunshot wounds of the abdomen. Features, diagnosis and treatment in modern conditions. SPb., Sintez Book, 2018:320. (In Russ.).

2. Martin M. J., Brown C. V., Shatz D. V. et al. Evaluation and management of abdominal gunshot wounds: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2019;87(5):1220‒1227. https://doi.org/10.1097/TA.0000000000002410.

3. Trishkin D. V., Kryukov E. V., Alekseev D. E. et al. Military field surgery. National leadership. 2nd ed. Samokhvalov I.M., editor. Moscow: GEOTAR-Media; 2024. 1056 p. (In Russ.).

4. Minnullin I. P., Magamadov A. H., Taranov I. I. Explosive abdominal injuries. SPb., SpecLit, 2022:191. (In Russ.).

5. Jeffery S. The management of combat wounds: the British military experience. Adv. Wound Care. 2016;5(10):464–473.

6. Kasimov R. R., Prosvetov V. A., Samokhvalov I. M. et al. The structure of combat surgical trauma and features of providing surgical care in advanced medical groups during the active phase of hostilities. Military Medical Journal. 2024;345(7):4–12. (In Russ.). https://doi.org/10.52424/00269050_2024_345_7_4.

7. Sazonov A. A., Romashchenko P. N., Makarov I. A. et al. Differentiated approach for using vacuum-assisted laparostomy in gunshot abdominal wounds. Grekov’s Bulletin of Surgery. 2023;182(6):11–18. (In Russ.). https://doi.org/10.24884/0042-4625-2023-182-6-11-18.

8. Malova A. R., Tenkova A. N., Chueva T. V. Kidney position anomalies. Integrative Trends in Medicine and Education. 2022;4:160–162. (In Russ.).

9. Unguryan V. M., Grinyov M. V., Demko A. E., Povzun S. A. Iatrogenes of manipulator character in abdominal surgery. Grekov’s Bulletin of Surgery. 2013;172(5):046–050. (In Russ.). https://doi.org/10.24884/0042-46252013-172-5-046-050.

10. Antonov A. V., Yadykin A. A., Makarov S. A. Laparoscopic nephrectomy for pelvic renal dystopia complicated by end-stage hydronephrosis. Urological Records. 2015;5(1):54. (In Russ.).