Bullet in the Brain!

Mrs S, a 25 year old lady presented to us with an accidental bullet injury which had occurred a year previously. She had undergone surgery elsewhere but the bullet could not be safely extracted. In addition she had skull defects over the left side of the forehead where the bullet had entered and over the back of the head on the right side, where the previous surgery was done.

Finding a foreign body inside an organ is always a challenge because these foreign bodies often shift position and one may have to cut through normal, healthy tissue to reach the foreign body. Things are further complicated if an attempt has already been made which has distorted the anatomy. More so, if the injury was an old one as in this case.

Surprisingly Mrs S was quite normal to an untrained eye, with no apparent weakness or infirmity except for suffering from severe headaches.

In a relatively quick two-hour surgery, we reconstructed the skull defect in the forehead region using titanium mesh and titanium mini screws. Then we operated upon the site of the previous exploration over the right side back of the head and were able to pinpoint the position of the bullet using intra-operative X-rays.

The bullet shell was successfully extracted with no significant damage to the brain and the patient made a smooth, uneventful recovery.