Doctors remove bullet from 16-year-old’s skull 3 months after mishap, save his life

 

Sagaya Fernando

Mumbai: 21 October 2020

 

Attempt to make a firearm at home backfired on a 16-year-old in Sikkim state of India. He was injured when the firearm misfired, when he was apparently testing it around three months ago, and the bullet pierced through his forehead above the left eye. But instead of rushing to a hospital to remove the shrapnel and get treated, the teenager decided against it, and only approached the doctors in September last week after he started getting unbearable headaches and vomiting. 

“The 16-year-old patient (name withheld for privacy) was brought to the emergency reception with complaints of headache, nausea and vomiting and fever for one month. Three months ago, he had an accident while trying out a firearm he had designed. After watching a few online videos on how to build a gun with readily available materials like metal pipes, rods and matchsticks, he built one for himself and decided to try it out in his backyard. The homemade firearm backfired and, in the process, he injured himself in the forehead. The exact details of the events are being investigated by the police at the moment,” informed consultant neurosurgeon Dr Pranav Rai at Central Referral Hospital (CRH), Gangtok, Sikkim, who along with his team conducted the surgery to remove the bullet from the patient’s skull. 

 

He further added, “Following the injury, the patient never lost consciousness and appeared normal except for the small skin wound in the left forehead and so he decided not to go to the hospital then. He took over the counter medications with which his wound healed with a superficial scar. He was alright for some time but soon started to experience a headache associated with nausea and vomiting.”

 

“He also had on and off high-grade fever with chills and rigor. Over the counter medications gave only temporary relief and over time his symptoms worsened progressively. Only when the medications stopped working, did he come to the hospital,” said Dr Rai.  

 

The CT scan and X-ray taken on September 22 reported of a metallic foreign body inside the skull.

 

“Contrast enhanced CT scan of the brain showed multiple pockets of pus with thickened capsules surrounding the projectile. There was also significant edema of the surrounding brain causing dangerous mass effect and impending cerebral herniation, all of which can be life threatening. He was explained and prepared for surgery a day later,” said Dr Rai. 

 

He added, “A left frontal craniotomy and removal of the projectile was performed. There were multiple encapsulated pockets of thick pus surrounding the projectile. High magnification operating neurosurgical microscope was used to carefully explore the brain without injuring the delicate vital structures. The country made projectile measuring around 2 cm long was removed successfully. Pus was drained from the cavities and the abscess capsules were excised using fine dissection. The cavities were then flushed with clean saline. The entry wound on the skull was in the form of a defect about 1.5 cm in diameter. This defect was repaired with a titanium mesh plate and screws.”

 

“The patient made a remarkable recovery from the surgery without any complications and neurological deficits,” said Dr Rai.

 

“Fortune favours the brave but not the foolish. He was fortunate enough to be alive after such a mishap in the first place. But his decision to avoid medical investigation and treatment nearly cost him his life. Ignorance and fear can often be bigger culprits than the actual problem itself,” stressed Dr Rai.

 

He explained, “Brain abscess is a serious condition and very often can be lethal. The human brain has a defensive fortress in the form of blood brain barrier which prevents entry of microorganisms. However, in certain conditions microbes do enter the brain and cause infection. Most common sources are the infections spreading directly from the ear and nose. In trauma organisms may enter the calvarium directly because of a penetrating injury or via the various interconnected sinus systems. Distant spread from other parts of the body may also occur. Most commonly the heart, lungs, bones and abdomen are involved. Common microorganisms are commensal of the skin and mucous linings. Microorganisms found in the soil and water may also be the causative agent. Tuberculosis and fungal infections are also common agents of abscess formation. Rapid multiplication and local immune response can lead to pus and abscess formation. Delay in treatment may lead to volume expansion of the abscess. Irritation of the surrounding brain tissue can lead to swelling or cerebral edema. The cumulative result may lead to fatal mass effect and brain herniation. Therefore, prompt diagnosis and treatment are mandatory to save life and prevent significant morbidity.”

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