Monday, June 14, 2010

Fortunate bullet wound

Some years ago a male patient in his forties came to the office with a hard swelling in the left buttock. He stated that it had been present for several years but had become larger over the latter few months and it was becoming more and more painful to sit. My examination revealed a hard, tender, localized swelling over the ischial tuberosity, the boney prominence that bears the seated weight in the normal buttock. It was much more prominent than the tuberosity on the right side. The history the man provided initially, was vague and seemed evasive, or at least uncertain. He had never seen a doctor about the complaint until his general practitioner referred him to me. I obtained an xray of the pelvis which showed a 22 bullet situated within the ischial tuberosity and surrounded by an expanding intraosseous cyst in a reactive shell of bone. Having established the diagnosis without any doubt, it was apparent that the history needed better disclosure if a surgical cure was to be undertaken. The patient confided that he had been surreptitiously visiting the wife of another, who rightly suspected her of a sexual liaison. The irate husband waited for proof and receiving it, then opened the bedroom door, in a rage, with his 22 rifle. My patient was frantically clearing out of the bedroom window when he received the gunshot wound in his buttock. This man was fortunate on several counts. The offended male never saw his face and couldn't describe any identifying features of his buttocks. He was shot with merely a 22, and so was able to still run on the fuel of adrenaline and avoided a hospital or clinic. The bullet remained intraosseous because of it's low velocity and the high resistance of bone. It did not stray into the bowel and bladder area where much damage could ensue. We booked his surgery with the generic description of, "Removal of foreign body", to avoid any further embarrassment. Salutary for mind and body!

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