It is very rare that surgery is performed solely for the purposes of bullet removal. Retained bullets rare cause complications and surgical attempts to find and remove these bullets usually cause more harm than good, if they are even successful. The patient below has a bullet sitting just posterior to the descending thoracic aorta. This would require a low thoracotomy to remove and may be lying in the muscle of the crus of the diaphragm:
Indications for bullet removal
Just under the skin, and residing in a pressure area where the bullet is painful when the patient sits or lies down.
Visibly bulging beneath the skin and causing cosmetic distress.
In a joint space
In the globe of the eye.
In a vessel lumen causing ischaemia or with the risk of embolisation to the heart, lungs or peripheral vessles.
Impinging on a nerve or nerve root and causing pain.
Localised abscess formation (usually due to dirt or clothing fragments entrained by the bullet).
Required for forensic investigation and the patient and surgeon are in full agreement that the removal will not result in increased pain, suffering, complications or injury and both agree to the removal.
Documented elevated lead levels, usually in a child and occurring several months after injury (extremely rare)
Management of the wound
Gun shot wounds of themselves need no intervention beyond a simple antisepsis and dry dressing. They do not need debridement and should not be closed. One shot of antibiotics should be given, especially if there is injury to bone.
Caesar Ursic, Ken Mattox, Chris Giannou, Ronald Gross