Bullet fragment within the appendix: a case report

A 9-year-old Caucasian male presented initially to his pediatrician with abdominal pain. The child underwent a UGI, which showed mild gastric erosions, however the scout film revealed a metal fragment lodged near the right sacroiliac joint on the AP view. The child was referred to a general surgeon who conducted a series of other diagnostic tests, which ultimately revealed and verified that the metal fragment was lodged in the distal appendix. Careful family history obtained showed that the family eats a great deal of wild game, including deer meat. It was felt that this metal fragment was a portion of a consumed bullet, which was retained in the appendix. The child's blood lead (Pb) level was elevated at 16ug/dl. An elective prophylactic appendectomy was performed due to the potential for developing appendicitis and possible lead toxicity.