Unusual metallic penile foreign body

Description

A man aged 85 years with severe dementia was brought to the emergency room by his wife because of gross haematuria and increasing agitation for a few days. Blood pressure was 89/56 mm Hg, heart rate 96 bpm and oxygen saturation 94% on room air. His abdomen was mildly distended in the suprapubic area without significant tenderness and a hard mass was palpated on the ventral side of the penile shaft. Laboratory studies showed septicaemia. CT of the abdomen and pelvis revealed a 6 cm bullet-shaped foreign body within the penile urethra (figures 1 and 2) and trace bilateral hydronephrosis. A 2 inch intact bullet was removed by urology without complications. The patient's wife stated that they had guns and ammunition in the house, but she did not know where he obtained this bullet. The patient was started on broad-spectrum antibiotics and his overall status improved.

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