Clinical Communications: Adults| Volume 45, ISSUE 3, e59-e62, September 2013

Undetected Penetrating Bladder Injuries Presenting as a Spontaneously Expulsed Bullet during Voiding: A Rare Entity and Review of the Literature



      Patients presenting with a penetrating missile lodged in the pelvis are at risk for having a urinary tract injury. Once in the bladder, the missile can become impacted in the urethra, causing retention that requires extraction. Rarely, the missile can be expulsed spontaneously through the urethra.


      To describe the world literature regarding undetected penetrating bladder injuries presenting as spontaneously voided bullets and to contribute an additional case to the literature.

      Case Report

      We present a case report of a 37-year-old man who sustained a gunshot wound to the right buttock, with an undetected urinary system injury and subsequent spontaneous voiding of a bullet.


      There have been <10 cases reported in the literature of spontaneously expulsed bullets from the urethra, all of which were undetected injuries on initial presentation. Physicians should be aware of the potential for undetected urinary tract injuries in patients with penetrating missiles to the pelvis and understand the appropriate evaluation and management strategies for these injuries.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rose D.
        Foreign bodies in the urinary tract.
        in: Urology. Volume 1. Saunders, Philadelphia1978: 843-862
        • Cohen S.P.
        • Varma K.R.
        • Goldman S.M.
        Spontaneous expulsion of intravesical bullet.
        Urology. 1975; 3: 387-389
        • Abdelsayed M.A.
        • Bissada N.K.
        • Finkbeiner A.E.
        • Redman J.F.
        Spontaneous passage of bullet during voiding.
        Southern Medical Journal. 1978; 71: 83-84
        • Kyriakidis A.
        • Karydis G.
        • Papacharalambous A.
        • Yannopoulos P.
        Spontaneous passage of shell fragments during voiding.
        Br J Urol. 1984; 56: 334
        • Sankari B.R.
        • Parra R.O.
        Spontaneous voiding of a bullet after a gunshot wound to the bladder: case report.
        J Trauma. 1993; 35: 813-814
        • DiDomenico D.
        • Guinan P.
        • Sharifi R.
        Spontaneous expulsion of an intravesical bullet.
        J Am Osteopath Assoc. 1997; 97: 415-416
        • Kumar Pal D.
        Spontaneous passage of shotgun pellets during voiding.
        Br J Urol. 1998; 81: 498
        • Kilic D.
        • Kilinc F.
        • Ezer A.
        • Guvel S.
        Spontaneous expulsion of a bullet via the urethra.
        Int J Urol. 2004; 11: 567-577
        • Caliskan M.
        • Evren I.
        • Kabak I.
        • Atak I.
        • Gokcan R.
        Masked urinary bladder injury with a bullet expulsed spontaneously during voiding.
        Ulus Travma Acil Cerrahi Derg. 2011; 17: 455-457
        • Lattimer J.K.
        Late erosion of shell fragment into the bladder.
        J Urol. 1946; 55: 483-485
        • Shiver S.A.
        • Reynolds B.Z.
        Urethral obstruction due to the passage of a retained projectile into the genitourinary system.
        Am J Emerg Med. 2008; 26: e1-e2
        • Bozeman W.P.
        • Mesri J.
        Acute urinary retention from urethral migration of a retained bullet.
        J Trauma. 2002; 53: 790-792
        • Weyrauch H.
        • Peterfy R.
        Tests for leakage in the early diagnosis of the ruptured bladder.
        J Urol. 1940; 44: 264-273
        • Chan D.P.
        • Abujudeh H.H.
        • Cushing Jr., G.L.
        • Novelline R.A.
        CT cystography with multiplanar reformation for suspected bladder rupture: experience in 234 cases.
        AJR Am J Roentgenol. 2006; 187: 1296-1302