Ahmed S I, S Khadim Hussain.
Migrating Foreign Body.
Pak J Surg Jan ;18(1):43-4.

A six years old child sustained bullet injury to left shoulder. The bullet in a week`s time had migrated through soft tissue and lodged in para rectal tissue from where it was retrieved by performing laparotomy.

A six years old male child was brought to civil Hospital Karachi with history of bullet injury three days back. He sustained injury from a stray bullet while playing in the field. He was treated at a local hospital where management of wound at top of left shoulder was done. Plain X-ray revealed bullet lodged in left lumber region. The child did not show any signs of internal injury. The child was admitted in our hospital about seventy two hours after primary injury. He was re-examined and no sign of internal injury e.g. haemorrhage or peritonitis was found, except wound of entry over the top of left shoulder. He was passing stool and urine normally. Repeat X-ray was done and this time the bullet was visualized down in the left hemipelvic area. On digital rectal examination bullet was palpable through rectum in the peritoneal cavity along the posterior abdominal wall. No rectal damage was felt and finger stall was clean. Operation was done through left paramedian incision and peritoneal cavity was explored. Right hand was passed into the pelvic cavity and the bullet was found to be lodged into the posterior abdominal wall just underneath of posterior peritoneum near the recto-sigmoid junction. It is concluded that bullet had migrated all the way from top of shoulder to pelvi-sacral region through posterior abdominal wall longitudinally without dam aging any important structure thus not producing any sign and symptoms. Post operative course was uneventful.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com