title: Undetected penetrating bladder injuries presenting as a spontaneously expulsed bullet during voiding: a rare entity and review of the literature.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To describe the world literature regarding undetected penetrating bladder injuries presenting as spontaneously voided bullets and to contribute an additional case to the literature.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
authors.forename: SreyRam
authors.initials: S
authors.lastname: Kuy
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Somberg
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Paul
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Brown
authors.forename: Allegra
authors.initials: A
authors.lastname: Saving
authors.forename: Panna A
authors.initials: PA
authors.lastname: Codner
mesh_terms: D000328:Adult; D002081:Buttocks / Q000293:injuries; D012809:Colon, Sigmoid / Q000293:injuries; D005547:Foreign Bodies / Q000209:etiology / Q000652:urine*; D006801:Humans; D008297:Male; D010538:Peritonitis / Q000209:etiology / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries*; D014948:Wounds, Gunshot / Q000150:complications*
keywords: genitourinary trauma; penetrating bladder injury