Ureteric Colic Due to Migrating Shotgun Pellet

Abstract

This is the second reported case of a bullet which entered the kidney, migrated to the bladder and passed spontaneously through the urethra. Case ReportA 25-year-old male was admitted to hospital with 20gauge shotgun wounds received at the house of his girlfriend. The shots were fired at 15 t o 20 yards range and struck him in the left buttock, the left flank area, the back and the soft tissues of the neck. He walked to the emergency room in satisfactory condition with normal vital signs and no evidence of intrathoracic or intra-abdominal injury. His urine was loaded with red blood cells. Chest X-ray showed no evidence of haemothorax or pneumothorax. The films of his abdomen showed the lead shots overlying the left iliac crest and the left upper quadrant of the abdomen, At noon on the second day following admission he began to have left flank pain which was typical of ureteric colic. At that time his white cell count had risen slightly to 14,000 but urine analysis was clear. The colic became more severe and 2 h later he passed a buckshot. His symptoms were immediately relieved.X-ray No. 1 (Fig. l), flat plate of the abdomen, revealed multiple buckshots in the left flank and buttock area. One of the pellets was located in the renal pelvic area.X-ray No. 2 (Fig. 2) was taken when the patient was having colicky left flank pain. The pellet from the left renal pelvic area is missing and is shown in the left distal ureter or bladder area.X-ray No. 3 (Fig. 3) was taken after the patient voided the pellet per urethram. Fig. 1 Buckshot wound in left renal pelvis area.Fig. 2 Pellet in bladder 24 h later.Fig. 3 Pellet expelled in urine. CommentA review of the English literature reveals only one case in which a missile fragment was passed spontaneously per urethrum (Begg, 1947). There are 3 recorded cases where the bullet entered the upper urinary tract and migrated down the ureter (Hewitt and Sanders, 1965;Bretland and Blacklock, 1968).This is the first case where the patient passed a pellet per urethrum as soon as 26 h after the injury. References Begg, R. C. (1947). Shell fragment migrating from kidney and passed per urethram after 23 years. British Medical Journal, Bretland, P. M. and Blacklock, N. J. (1968). Grenade fragment in the ureter: a recent case. British Journal of Urology, Hewitt, R. L. and Sanders, P. W. (1965). Acute ureteral obstruction from gunshot: report of an unusual case.

Re: “Late Presentation of a 9mm Bullet in the Ureteropelvic Junction Causing Acute Renal Failure in a Solitary Functioning Left Kidney” by Jhaveri and D'Angelo (J Endourol Case Rep. 2018;4:173–175)

“…Spontaneous passage per urethra of a shell fragment 23 years after initial injury has been described 2 and Gawande et al have also described a case of spontaneous passage of a gunshot pellet 2 hours after injury. 3 The passage of multiple spontaneous pellets has also been described. 4…”