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Why can’t you leave a bullet in?

When a person is shot, the standard procedure is to remove the bullet if possible. This raises the obvious question: why can’t you just leave a bullet in? There are several reasons why removing the bullet is usually the best course of action.

Risk of Lead Poisoning

One of the main reasons a bullet needs to be taken out is because of the lead content. Most bullets have a lead core covered in a jacket of copper or other metal. Lead is toxic, and having it remain in your body can cause lead poisoning. Even a small amount of lead can build up over time and cause health problems.

Some of the symptoms of lead poisoning include fatigue, headaches, irritability, loss of appetite, abdominal pain, memory loss, and tingling in the hands and feet. In severe cases, it can cause seizures, coma, and death. Leaving a bullet inside raises the ongoing risk of absorbing lead into the bloodstream.

Infection Risk

Bullets are not sterile. When a bullet passes through the skin, it carries with it microbes, debris, and fragments of clothing. Leaving these foreign objects inside the body raises the risk of infection developing around the wound site. The human mouth contains over 700 species of bacteria, and a bullet passing through carries some of this microflora into the tissues.

Even if infection does not develop immediately, there is an ongoing infection risk as long as the bullet remains inside. Bacteria can gradually colonize the bullet and surrounding damaged tissue over time. The longer the bullet stays in, the greater the chance bacteria have to establish an infection.

Tissue Damage

Bullets can cause significant tissue damage as they pass through the body. This may include:

  • Bone fractures
  • Nerve damage
  • Vascular injury
  • Organ lacerations
  • Hemorrhage and hematomas

Leaving the bullet inside does nothing to repair this tissue damage. The persistent presence of the foreign object can impede healing and increase scarring. There is also a risk the bullet could shift position and cause further damage or disrupt blood flow. Taking out the bullet allows for a fuller assessment and repair of internal wounds.

Pain and Discomfort

Having a bullet lodged inside can cause lingering pain and discomfort. This is due to the object pressing on nerve endings, inflammation around the wound site, and the body’s reaction to having a foreign material present. Patients often report an improvement in their pain levels after bullet removal surgery.

Functional Impairment

Depending on the bullet’s location, it can potentially interfere with normal functioning of muscles, organs, nerves, and joints. For example, a bullet in the abdomen could obstruct digestive processes. One near a joint may restrict mobility. Removing the bullet can help restore normal mechanics and reduce impairment.

Psychological Factors

For some patients, knowing there is a bullet inside them can cause significant anxiety, stress, depression, and emotional trauma. Removing the bullet allows for psychological closure and relief that the object is gone. However, mental health support may still be needed to process the trauma.

When Can a Bullet Be Left In?

There are some situations where removing the bullet may not be feasible or necessary. Factors doctors consider include:

  • Bullet location – If it is lodged deep in muscle tissue away from vital organs, removing it may cause more damage.
  • Bullet composition – Less toxic metals may pose little risk if left in place.
  • Patient condition – Their medical status may be too unstable for anesthesia and surgery.
  • Access issues – It may be challenging to reach the bullet without extensive dissection.
  • Quality of life – If the bullet is not causing problems, the patient may opt to leave it in.

However, these cases require careful consideration of the benefits and risks. Over time, a bullet initially left in may still need to be removed if complications arise.

Surgical Removal Procedures

When a bullet does need to be extracted, there are several surgical procedures used:

Wound Exploration

In some cases, the bullet is located close to the wound entrance and can simply be removed through the existing hole. This may require enlarging the wound opening, but avoids additional incisions.

Minimally Invasive Surgery

Methods like laparoscopy and endoscopy allow for visualization and access to bullets through very small incisions. Instruments and cameras are inserted through tubes into the body. This results in less postoperative pain and faster recovery times.

Open Surgery

For bullets lodged deeper in the tissues or in complex anatomical regions, traditional open surgery may be required. This involves larger incisions to gain access and directly visualize the bullet for removal. Muscle and connective tissue may need to be dissected to locate the object.

Procedure Description Recovery Time
Wound Exploration Enlarging existing wound opening to remove accessible bullets 1-2 weeks
Minimally Invasive Surgery Use of endoscopes and laparoscopes to extract bullets through small incisions Up to 1 week
Open Surgery Large incisions and direct visualization to access deeper bullets 2-6 weeks

The surgical approach depends on the circumstances of each case. Doctors balance the need to remove the bullet with the least invasive method possible.

Possible Complications

While bullet removal procedures are usually successful, there are potential risks and complications:

  • Infection – Wound infections may occur after any invasive procedure.
  • Bleeding – Vascular structures may be damaged, requiring transfusions or repeat surgeries to control hemorrhage.
  • Nerve injury – Nearby motor and sensory nerves may be cut or damaged.
  • Organ injury – Surrounding organs may be inadvertently punctured during dissection.
  • Anesthesia reactions – Some patients may have adverse responses to general anesthesia or numbing medications.
  • Failure to remove fragments – Tiny pieces may remain if the bullet shatters.
  • Recurrence of symptoms – Pain or functional problems may persist even after bullet removal.

However, when performed by an experienced trauma surgeon, the overall risks are low. Taking precautions like antibiotics, sterile techniques, and meticulous hemostasis can help reduce complications.

Post-Operative Care

After bullet removal surgery, some key aspects of post-operative care include:

  • Pain management – Medications are given to keep patients comfortable during recovery.
  • Antibiotics – Prescribed prophylactically to prevent infection.
  • Wound care – Keeping the incision clean and watching for signs of infection.
  • Fluid management – Avoiding dehydration and replacing lost blood.
  • Gradual increased activity – Slowly resuming normal movement as healing allows.
  • Follow-up exams – Monitoring for complications and assessing recovery.

Following all post-op instructions carefully, including coming to follow-up appointments, can help ensure optimal healing.

Physical Therapy

Depending on the bullet’s location and the extent of tissue damage, physical rehabilitation may be recommended. A customized therapy program can help strengthen muscles, improve range of motion, and train coordination. This aids the return to normal limb function and daily activities.

Psychological Support

Counseling may be suggested to help process the psychological trauma of being shot. Even after bullet removal, anxiety, depression, and PTSD are common. Talk therapy provides skills to manage emotions and cope with the mental impact.

Long-Term Outcomes

With proper treatment, most patients do well after bullet removal and have positive long-term outcomes:

  • No lead toxicity – Taking out the bullet prevents higher lead levels.
  • Lower infection risk – The source of potential infection is eliminated.
  • Improved functionality – Removal can restore normal use of tissues and organs.
  • No pain – Up to 90% experience complete resolution of discomfort.
  • Psychological benefits – Many report improved mental health and quality of life.

However, even with removal, some may continue to have residual effects like pain, numbness, weakness, or decreased mobility. Additional procedures or chronic treatment may be required in certain cases.

When to Seek Follow-up Care

After bullet removal, it is important to monitor for warning signs of complications and promptly seek medical care if they occur:

  • Fever, chills – Could indicate an infection.
  • Continued bleeding from incision site – Concerning for hematoma.
  • Sudden or worsening pain – May signify nerve injury or abscess.
  • Numbness, tingling, weakness – Suggests nerve damage.
  • Difficulty moving or using limb – Signals loss of function.
  • Labored breathing, cough – Can happen with lung injury.
  • Abdominal distension, vomiting – May mean an intra-abdominal problem.

Follow-up care is vital for monitoring recovery and addressing any issues early.


Removing a bullet is usually recommended whenever feasible due to the risks of leaving it inside the body. Potential complications include lead poisoning, infection, pain, organ damage, and physical impairment. Various surgical techniques can be utilized based on the bullet’s location and trajectory. While there are risks to any procedure, bullet removal often has good outcomes and prevents long-term consequences. However, some post-operative care and follow-up is necessary. With proper treatment, most patients can expect to make a full recovery and return to normal function.