Late Presentation of a 9 mm Bullet in the Ureteropelvic Junction Causing Acute Renal Failure in a Solitary Functioning Left Kidney

Background: Urinary obstruction as a result of a late complication of a gunshot wound is rarely reported. Bullet shell fragments may migrate from their initial location into an area causing obstruction. In this study, we present a case of a left renal calculus surrounding a 9 mm gun shell in a patient with a solitary functioning left kidney. Case Presentation: A 53-year-old man presented with left hydronephrosis found on an urgent CT scan following complaints of left flank pain and signs of acute renal failure 10 years after suffering a gunshot wound to the abdomen. Urgent cystoscopy and bilateral retrograde pyelograms revealed a left ureteropelvic junction calculus surrounding a 9 mm bullet fragment that was ultimately removed percutaneously. Conclusion: Abdominal gunshot shell fragments may migrate over time causing urinary obstruction. In this case the past medical history of the previous gunshot wounds provided insight into the etiology of the patient's actual clinical presentation. This led to the best endoscopic approach for the effective treatment of this unique case.