Masked urinary bladder injury with a bullet expulsed spontaneously during voiding

Area of Science:

• Urology
• Trauma Surgery
• Radiology

Background:

• Pelvic gunshot wounds can result in complex injuries requiring careful management.
• Intravesical foreign bodies, such as bullets, present unique diagnostic and therapeutic challenges.
• Spontaneous expulsion of intravesical bullets is an exceptionally rare occurrence in medical literature.

Observation:

• A 19-year-old male sustained a gunshot wound to the pelvis with the bullet lodged between the rectum and urinary bladder.
• Initial assessment revealed no visceral injury but macroscopic hematuria post-catheterization.
• Conservative management was chosen, with close monitoring and no surgical intervention.

Findings:

• The bullet was spontaneously expelled via the urethra during normal voiding five days after injury and catheter removal.
• Post-expulsion urethrography confirmed no residual urinary tract or bladder injury.
• This case represents a rare instance of spontaneous transurethral bullet expulsion.

Implications:

• This case underscores the potential for conservative management in select cases of pelvic gunshot wounds with intravesical bullet migration.
• It contributes to the limited literature on spontaneous bullet expulsion, offering insights for trauma care.
• Further research into predicting spontaneous expulsion versus surgical intervention is warranted for optimizing patient outcomes.