This study presents the unique case of a 25-year-old male who arrived at an Australian rural emergency department with shotgun wounds to the back and arm with a projectile tract passing through the right renal parenchyma and collecting system, which was able to be managed conservatively. The objective of this study is to highlight the management of penetrating renal injuries.

Informed, written consent was obtained from the patient to provide authorization to present the details of his case. Clinico-pathological and radiological data were recorded and presented in chronological order to illustrate the management pathway offered. A narrative literature review was conducted to compare the clinical course of this patient with prior data on similar traumatic injuries.

Despite a dramatic renal laceration seemingly transecting through the upper pole, no urine leak or active, expanding haemorrhage was identified in this patient, who remained haemodynamically stable throughout his presentation. Whilst operative management has traditionally been recommended upfront for penetrating abdominal injuries, previous studies have indicated that judicious use of observation as an alternative is acceptable in selected, stable patients, who have been adequately and serially assessed. This case report exemplifies the successful use of conservative management for a renal gunshot injury, with the benefit of avoiding potentially significant morbidity associated with operative interventions that typically otherwise ensue.

The case presents an insight into the management of penetrating abdominal injuries in the Australian rural setting, with a specific demonstration of the role of observation for penetrating renal injury from gunshot wounds.