Management of a Retained Bullet in the Corpora Cavernosa after a Civilian Gunshot Injury: A Rare Scenario

Abstract

A 24-year-old man presented to King Saud Medical City emergency department with a retained bullet in his penis following a civilian exchange of gunfire. After an initial assessment, the patient was taken to the operating room. Penile exploration was performed, the bullet was extracted successfully, and the corpora cavernosa were repaired properly. A 6-week follow-up showed full healing with preservation of erectile function. Immediate surgical intervention is mandatory as the primary treatment for penile gunshot injury to ensure proper anatomical and functional recovery.

Retained Bullet in the Penis

“…Typically, gunshot wounds to the penis are through injuries, so having a retained bullet within the penis is a unique clinical scenario. During our review of the literature, we were able to find three other case reports similar to our patient in which the bullet was actually retained within the penis [5][6][7]. One of the cases involved an entry wound to the left buttocks with the bullet tracking to the penis but not exiting [5].…”

“…Another case involved the bullet passing through another individual's abdomen and then lodging within the penis of the man standing behind him [ 6 ]. In Saudi Arabia there was a case similar to our patient in which the bullet initially entered and exited the upper thigh before finally lodging within the penis [ 7 ].…”

Case – Management of bullet retained in penile shaft after drive-by shooting

“…Only three other cases of retained bullets in the penis have been described in the literature. [3][4][5] In one of these cases, the bullet was superficial and was removed at the bedside without formal penile exploration. 3 The other two reports describe penile exploration with removal of the bullet and repair of the tunica albuginea.…”

“…3 The other two reports describe penile exploration with removal of the bullet and repair of the tunica albuginea. 4,5 Due to the rarity of the described injury, specific guidelines pertaining to diagnosis and management are lacking. Generally accepted principles for managing penile penetrating trauma include: prompt penile exploration if corporeal injury is suspected, urethral evaluation with either cystoscopy or retrograde cystogram if there is blood at the urethral meatus, inability to void or gross hematuria, and repair of corporeal and/or urethral defects if encountered.…”

“…Furthermore, several authors advocate for artificial erection testing to localize corporeal injury and assess for repair adequacy. 4,7 This step was omitted in the described case as the brisk bleeding that was encountered prior to the application of a penile tourniquet stopped entirely after repair.…”