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Home > Articles > Indications for Bullet Removal

Introduction

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

  1. Just under the skin, and residing in a pressure area where the bullet is painful when the patient sits or lies down.

  2. Visibly bulging beneath the skin and causing cosmetic distress.

  3. In a joint space

  4. In the globe of the eye.

  5. In a vessel lumen causing ischaemia or with the risk of embolisation to the heart, lungs or peripheral vessles.

  6. Impinging on a nerve or nerve root and causing pain.

  7. Localised abscess formation (usually due to dirt or clothing fragments entrained by the bullet).

  8. 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.

  9. 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.

Contributors

Caesar Ursic, Ken Mattox, Chris Giannou, Ronald Gross

Comments

Tim Hardcastle, August 24, 2007

Karim

I suspect there were a number of other contributors to this list! It is comprehensive and I am in full agreement. Usually a bullet IN the globe of the eye is removed WITH the globe!

Tim

cgilbert, April 10, 2008

What about a bullet that has passed through colon and is now embedded in the gluteal muscle or thigh muscles.  Several years ago I had a patient who died following a rapidly necrotizing fasciitis in this situation.  I wonder if debriding the track with or without retrival might have spared him this outcome.and

Tim Hardcastle, April 16, 2008

Dr Gilbert

The literature to date does not support the need for aggressive debridement of bullet tracts. The unlucky few who get Nec. Fasciitis would be likely to get the same with or without debridement or tract washouts. The is even a study that shows most grade 1 fractures after bullets need not routinely be washed out.

Tim

Dr.A. S. Al-ani,general surgeon,Khorfakkan,UAE, November 17, 2008

Dear Karim,
What about intra-cranial bullet result in a focus of epileptic fits resistant to medical treatment?

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