<- Home <- Arhive <- Vol. 24, Issue 1, March 2016

Rom J Leg Med24(1)7-10(2016)
© Romanian Society of Legal Medicine

An old retained metallic bullet with far distance displacement and unusual presentation

A. Aghabiklooei, M. Baghaei, F. Fallah

Abstract: Legal medicine departments are almost always involved during the management of gunshot injuries; therefore, having enough knowledge about the management of gunshot victims is essential for the experts in this field. In cases of gunshot injuries without an exit wound, the retained bullet must be located. Migration of retained bullet should always be suspected but its pathway and direction is unpredictable. When the retained bullet is not detectable in the expected area exploratory imaging is necessary. In this report, we describe the case of an old woman who was shot accidentally in the suprascapular region, the bullet remained in her body and had a multistage migration: from the soft tissue of the suprascapular region (the primary site) to the biliary system where it remained for three years; it was afterwards displaced within the biliary system causing biliary obstruction and related symptoms; finally it migrated rapidly from the common bile duct to the colon. This article will discuss diagnosis and surgical problems associated with multistage bullet migration. This case reveals the importance of whole body inspection in gunshot victims for exit wounds, including through imaging methods and clarifies the need for regular follow-up in victims with retained bullets even when they are asymptomatic.
Keywords: retained bullet, migration, gunshot wound, missile, cholestasis.

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