The ICRC Metallic Foreign Bodies After War Injuries: Should We Remove Them? Experience

The presence of metallic foreign bodies is a relatively common finding on the x-rays of war-wounded patients. They usually represent entire bullets or part of them, or fragments from bombs or mines. They often catch the attention of the patient and his/her relatives who impute to them the cause of pain and disabilities and insist with the doctor for their removal, even when the soft tissues wound has completely healed. The experience of the ICRC (International Committee of the Red Cross), based on a surgical database of more than 36,000 war wounded patients registered and 200,000 operated in ICRC supported hospitals around the world, shows that these operations are often risky, useless, consume time and material. They result in new surgical trauma with its possible complications, often without identifying and removing the foreign body. The relatively few indications for removal of these foreign bodies are listed together with a simple stereo tactic method to locate them. A special mention of the effective risk of lead poisoning is made as this is sometimes pleaded as a reason for removal of retained bullets.