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Migrating Souvenir Bullet: The Management Dilemma
Srikant Kumar Swain1, Rajnish Kumar Arora1, Radhe Shyam Mittal1
1Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Annals of Neurosciences
|November 4, 2021
Summary
A retained bullet in the head after gunshot trauma can be managed conservatively if asymptomatic. Long-term monitoring is advised for potential complications like bullet migration or abscess formation.
Area of Science:
- Neurosurgery
- Trauma Surgery
Background:
- Cranio-cerebral trauma from gunshot injuries has high mortality.
- Deciding on retained missile removal presents a clinical dilemma for physicians.
Observation:
- A 21-year-old man sustained a forehead injury from a bullet.
- Initial imaging revealed a retained bullet in the left parieto-occipital region without significant hemorrhage or neurological deficit.
Findings:
- Conservative management was initiated due to the absence of neurological deficits.
- Over 28 months, the bullet migrated to the right temporal region without causing symptoms.
Implications:
- Asymptomatic patients with retained intracranial bullets may be managed conservatively.
- Long-term follow-up is crucial to monitor for delayed complications such as bullet migration, hydrocephalus, or abscess formation.
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