2026 Volume 12 Issue 1 Article ID: cr.25-0738
INTRODUCTION: Penetrating abdominal trauma poses a major challenge in trauma surgery, with most cases resulting from knives or firearms. This report describes a rare case caused by deer antlers and highlights the role of diagnostic laparoscopy.
CASE PRESENTATION: A 77-year-old man presented with epigastric and right flank pain after deer antler penetration. On arrival, he was hemodynamically stable but diaphoretic. Physical examination revealed two abdominal wall wounds without obvious contamination. Ultrasonography revealed free fluid in the upper abdomen. Contrast-enhanced CT identified two abdominal wall defects and intraperitoneal fluid but no solid organ injury. Given the risk of occult organ injury and bacterial contamination from the antlers, emergency diagnostic laparoscopy was performed. Laparoscopy revealed approximately 800 mL of hemoperitoneum. Findings suggested that the antler had penetrated the abdominal wall and falciform ligament and reached the left margin of the hepatoduodenal ligament. Peritoneal lavage and subphrenic drain placement were then performed. The operative time was 90 minutes, and no transfusion was required. The patient was discharged on POD 6 without any complications. Retrospective review of preoperative imaging and operative video revealed a small penetrating liver injury that had achieved spontaneous hemostasis and was considered the source of hemoperitoneum.
CONCLUSIONS: Diagnostic laparoscopy is effective and safe for hemodynamically stable penetrating abdominal trauma, including injuries caused by uncommon mechanisms such as animal horns. While it facilitates accurate assessment and lavage, surgeons must remain aware of its limitations, particularly the risk of missed injuries with complex trajectories or spontaneous hemostasis.
