Foreign body ingestion is a common problem among the pediatric population, but intrabdominal foreign bodies lying freely in the peritoneal cavity are rare. Normally an ingested Foreign Body is left to pass out spontaneously without expecting any harm. There are instances when the Foreign body may perforate the bowel and lay freely in the peritoneal cavity. Gunshot or firearm injuries are very rare in children.
Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. Patients with diffuse abdominal tenderness and hemodynamically unstable should be taken emergently for laparotomy.
CT Scan is an effective tool in the diagnosis of the presence of foreign body and its exact location. Negative laparotomies result in longer hospital stay and have an overall higher morbidity and mortality with a higher incidence of complication such as pneumonia, wound infection, wound dehiscence, abscess formation, and also long term complications such as bowel obstructions from adhesions.
The video below shows a case with a gunshot entry wound at the right anterior abdominal wall, without exit wound.