Blood Lead Level Elevation as a Result of a Retained Bullet

A 6.5-year old girl was brought to the emergency room with a gunshot injury. Bullet entry hole was under the right scapula, but no exit wound was found. Abdominal examination revealed no tenderness. No free air was seen under the diaphragm on the plain radiogram. Abdominal CT scan demonstrated minimal contusion in the liver and the bullet was detected in the pelvis near the right side of the urinary bladder (Fig.1). Patient was hemodynamically and neurologically stable. Before discharge on the 4th day of the gunshot injury, serum lead level was 1.9μgr/dl. Monthly follow-up was done via radiological evaluation and serum lead levels. At 4 months follow-up, the patient developed mild apathy and irritability. Her serum lead level was found to be 18.0μgr/dl, so a decision for surgical intervention was taken. A single-port trans-umbilical laparoscopy revealed bullet wrapped by the omentum. The bullet was extracted after partial omentectomy. Blood lead levels returned to normal on follow-up with improvement of apathy.