Spontaneous passage of an accidentally ingested metallic bullet casing in an adolescent: a case report

Accidental ingestion of foreign objects is a frequent emergency presentation that can lead to serious complications. It is most often seen in children and high-risk adults, but remains rare in healthy adolescents without predisposing factors.

We describe a 17-year-old female who accidentally swallowed a metallic bullet casing during a meal. She presented two hours later with only a mild sore throat. Serial abdominal radiographs demonstrated progressive passage of the casing through the gastrointestinal tract without perforation or obstruction. With close inpatient monitoring, including clinical evaluations and sequential imaging, the casing was spontaneously expelled per rectum. The patient remained asymptomatic, and follow-up showed no complications.

Most blunt, small foreign bodies pass spontaneously. This case highlights that, in carefully selected asymptomatic patients, conservative management with vigilant monitoring is a safe and effective alternative to invasive intervention.

Conservative management can be both safe and effective in healthy adolescents who accidentally ingest a foreign body, provided there are no clinical or radiological signs of obstruction, perforation, or other complications.