When a person sustains a gunshot wound, a bullet or its fragments may sometimes remain within the body. This decision is based on careful medical evaluation of the specific circumstances of the injury.
Why Bullets Are Sometimes Left In
Surgical removal can sometimes pose greater risks than leaving a bullet in place. A projectile lodged deep within sensitive tissues, near major blood vessels, or vital organs like the brain or spinal cord, presents a complex surgical challenge. Attempting extraction might cause more damage, such as excessive bleeding, nerve injury, or organ perforation. In some cases, a bullet might even be holding pressure on an artery, where removal could lead to rapid blood loss.
The body often walls off foreign objects with fibrous tissue, encapsulating the bullet and preventing its movement. This minimizes the risk of infection or further damage. If a bullet is in a non-critical area and not causing immediate symptoms, a conservative approach is often adopted.
Early Health Considerations of Retained Fragments
Even when a bullet is left in, its presence can trigger early health considerations. Localized inflammation is a common immediate response, causing pain and swelling around the impact site.
Acute infection is a concern, especially if the bullet carried contaminants into the wound. Bacteria can proliferate around the retained fragment, leading to abscess formation. Prompt antibiotic treatment is often necessary to manage this risk.
If a bullet or fragment is situated near a nerve, it can cause nerve impingement, leading to symptoms like numbness, tingling, weakness, or localized pain. Early migration of fragments can also occur, potentially causing new pain or dysfunction if they shift into a more sensitive location or obstruct a vessel.
Potential Long-Term Health Issues
Over time, retained bullets can lead to various chronic complications. Lead poisoning is a notable concern, especially from older or specific bullet types containing lead. Lead can leach from the projectile into surrounding tissues and eventually into the bloodstream, leading to elevated lead levels. The risk of lead toxicity increases significantly if the bullet is located within a body fluid compartment, such as a joint.
Chronic pain is another frequent long-term issue, often stemming from nerve damage, persistent inflammation, or the bullet’s proximity to joints or bones. Nearly 68% of firearm injury survivors report daily pain 6 to 12 months after injury. This pain can range from a dull ache to sharp, debilitating sensations.
Nerve damage can result in persistent numbness, tingling, or weakness if the bullet remains near or impinges upon a nerve. The bullet’s presence can also contribute to a pseudoaneurysm, a localized collection of blood outside an artery that can expand and potentially rupture. If a bullet is lodged near a joint, it can contribute to arthritis due to chronic irritation and inflammation. Fragments can also migrate years later, potentially causing new symptoms if they move to a critical area.
Monitoring and Care for Retained Bullets
Patients with retained bullets typically undergo regular medical monitoring to assess their health and the bullet’s status. Follow-up appointments allow healthcare providers to check for any new symptoms or complications.
Imaging studies, such as X-rays or CT scans, are often performed periodically to monitor the bullet’s position and detect any signs of migration or changes in the surrounding tissue. These scans help identify potential issues like inflammation, nerve impingement, or early signs of lead leaching. Magnetic resonance imaging (MRI) can also be performed safely in many cases with retained fragments.
Symptom management is a core component of care, addressing pain, discomfort, or other issues as they arise. Patients receive education on what symptoms to watch for, such as increased pain, swelling, numbness, or signs of infection, and when to seek immediate medical attention. If new complications develop or symptoms become debilitating, a previously retained bullet might eventually be removed.