Successful Removal of a Bullet from the Spinal Canal of a GSW Victim in the Level of L5: Case Report

INTRODUCTION AND IMPORTANCE: Gunshot wounds (GSWs), for increasing violence in urban areas globally and especially among the young population, have been significant causes of morbidity and mortality. These are the most common cause of spinal cord injuries, followed by traffic accidents. The priority of the therapeutic team is to save the victim and then minimise the permanent neural deficits. The indications for lumbosacral decompressive spinal surgery have remained challenging. CASE PRESENTATION: A 25-year-old man victim of a gunshot in his left flank presented to the emergency department in hemodynamic shock and lethargy status. Resuscitating with fluids, he underwent damage control surgery (DCS). Sources of 2.5 l of intra-abdominal blood were detected of multiple intestinal and mesentery perforations beside the left ureter complete cut. The left psoas muscle was through and through perforated, too, and the bullet was stuck between the vertebrae. On the fifth day after DCS, the bullet surgical removal of the bullet was done in which L2-S1 laminectomy approaching the crushed Conus terminalis was completed. After the operation, his left foot drop and walking ability were improved. CLINICAL DISCUSSION: Surgical treatment for gunshot wounds in the spinal column is controversial, but the emphasis is on providing advanced trauma life support. Definite treatment of such lesions mainly focuses on maintaining spinal stability, decreasing neurologic deficits as much as possible, and preventing complications. CONCLUSION: A patient indicates neurological surgery who is young with incomplete or progressive neurology deficits, unstable spine, or complete injury with persistent neural compression.