Not shooting blanks: A case of foreign body urinary retention

Bullet and other foreign body migration after penetrating trauma is rare. There is potential for delayed movement and migration over time. A migrating retained foreign body can cause serious complications. A 51-year-old male sustained a gunshot wound to the abdomen and pelvis. The bullet initially lodged in the abdomen. Trauma imaging identified cancer and the patient required surveillance scans. The position of the bullet remained unchanged for 11 months. From 11-15 months, imaging showed the bullet migrating across the abdomen, into the bladder, and through the prostate, ultimately causing acute urinary retention in the urethra. The patient presented with severe pain and was found to have bladder distention and the bullet 5 mm from the urethral meatus. It was successfully removed under sedation using alligator forceps followed by Foley catheter placement. This case illustrates the rare but significant risk of delayed bullet migration and the need for long-term monitoring in penetrating trauma with retained foreign body.