A 59-year-old patient was admitted with a gunshot wound with an entrance hole in the buttock, about 4 mm in diameter and without an exit wound.
It also presents another bullet wound in the right thigh with entrance wound behind and exit wound forward, without involvement of important structures.
The patient is conscious, oriented and with slight abdominal defense.
A bullet located at the level of the symphysis of the pubis, as well as a fracture of the right descending branch of it, appears in the simple abdominal X-ray.
The patient arrives in retention and catheterization is impossible, so a suprapump catheter is placed.
Laparotomy was performed, and no other lesions were found. Left atrial fibrillation was diagnosed.
The next day an urethrography is performed, proving that there is a passage of contrast from the urethra to the rectum, causing high fever with chills that are maintained for a few days.
Subsequently, five days after the first intervention, the patient was taken to the operating theatre and underwent rectal perforation.
Then an endoscopic urethrotome is introduced into the prostatic urethra, visualizing the apparently large orifice that connects the urethra with the rectum.
In spite of all, it is possible to find the path that leads to the bladder and finally a 18-gauge catheter is left.
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Then, in the same surgical procedure, a laparotomy is performed until the symphysis of the pubis, the abdomen is again reviewed and it is proven that there is no injury.
The space of Retzius is then dissected and, by means of radiological control, the anterior prostate gland is dissected, which is hypertrophic until the projectile is touched.
Then, with a ring clamp and always under radiological control, the bullet can be grasped and removed.
The postoperative course was uneventful and the patient was discharged a few days later with the catheter.
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At three months the patient is asymptomatic, a new rectal orifice is made and it is verified that the rectal orifice has closed and there are no incidents.
However, the catheter is left for three more months, a total of six months.
After this time an urethrography is performed again, it was found that the gap has closed and the catheter is removed.
Six months later, the patient returns for control, is asymptomatic and has normal sexual function. This time only ultrasound is performed, which is normal and is given definitive discharge.
