title: Migrating bullet in the thecal sac at the level of the conus medullaris without neurological deficit.
abstract: Bullets can lodge in the organs, blood vessels or thecal sac. To our knowledge, a migrating bullet at the level of the conus medullaris without neurological deficit has never been reported. We present our patient along with a discussion of bullet migration in the spinal canal and its mechanisms, diagnosis and treatment. A 29-year-old man was admitted to the emergency department due to a gunshot wound in the right upper quadrant of his abdomen. He had no neurological deficit. Spinal CT scan and plain radiography showed the bullet had passed through the L2 vertebral body and had migrated downwards until it had lost its energy and come to rest in the spinal canal at the L3 vertebra level. There was a grade 5 injury to the pancreas head concomitant with mesenteric injury of the transverse colon, harboring a 0.5 cm hole. He had an emergent laparotomy to have a Roux-en-Y reconstruction and repair of the transverse colon. After his general status stabilized, he was taken back to the operating room to extract the bullet from the spinal canal. L3 and partial L2 laminectomy were performed. The dura was opened and the bullet was observed intrathecally. No cerebrospinal fluid fistula was observed. The surgeries and post-operative period were uneventful.
authors.affiliation: Department of Neurosurgery, Kurtköy Ersoy Hospital, Istanbul, Turkey.
authors.forename: Orkun
authors.initials: O
authors.lastname: Koban
authors.affiliation: Department of Neurosurgery, Batman State Hospital, Batman, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Çal
authors.affiliation: Department of Orthopedic Surgery, Spine Center, University of California San Francisco, 500 Parnassus Avenue, MU320 West San Francisco, CA 94143-0728, USA. Electronic address: muratsakireksi@gmail.com.
authors.forename: Murat Şakir
authors.initials: MŞ
authors.lastname: Ekşi
authors.affiliation: Department of Orthopedic Surgery, Spine Center, University of California San Francisco, 500 Parnassus Avenue, MU320 West San Francisco, CA 94143-0728, USA.
authors.forename: Emel Ece
authors.initials: EE
authors.lastname: Özcan-Ekşi
authors.affiliation: Department of Neurosurgery, Batman State Hospital, Batman, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Öğrenci
mesh_terms: D000328:Adult; D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D005548:Foreign-Body Migration / Q000473:pathology*; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D013116:Spinal Cord / Q000473:pathology* / Q000601:surgery*; D014948:Wounds, Gunshot / Q000473:pathology* / Q000601:surgery*
keywords: Bullet; Migration; Neurologic deficit; Spinal cord; Spine