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847Vol. 10    |    No. 2    |    Spring 2013    |U R O LO G Y   J O U R N A L

Department of Urology, Aintree 
University Hospital, Lower 
Lane, Liverpool, L9 7AL, United 
Kingdom

* E-mail: Jmac@doctors.org.uk

A 42-year-old man presented with a three-day history of acute 

Following his initial presentation, he required an exploratory lapa-
rotomy, gastric oversew, and transverse colon repair, but was still 
known to have multiple remaining intra-abdominal pellets (Figure 
1). He had no previous urological history, but urinalysis on admis-
sion revealed microscopic hematuria. Renal function was normal, 
but his C-reactive protein was increased at 38 mg/L (normal value 
<10 mg/L). A non-contrast computed tomography revealed one 
pellet had migrated into the left ureter causing ureteral obstruction 
and hydronephrosis (Figure 1).
Initial management involved decompression of an infected system 
with a percutaneous nephrostomy followed by an antegrade pyle-

and involved delayed ureteroscopy and extraction of the pellet un-
der general anesthesia. The pellet was extracted with forceps, and 
a ureteral stent was inserted for a period of four weeks due to the 
nature of the foreign body and to permit ureteral healing. There 
were no complications during the procedure or during the urologi-
cal follow-up of the patient.
Ureteral obstruction caused by a foreign body is uncommon.(1,2) 
When suspected, it is usually an indwelling ureteral stent;(1) how-
ever, rarer causes, such as shotgun pellets and bullets, have been 
described.(2) In previous reports of shotgun pellets causing ureteral 
obstruction, the pellets have passed spontaneously without the 
need for further intervention.(1-3) This case highlights the multidis-
ciplinary approach to the management of ureteral foreign bodies 
due to gunshot injuries, and the fact that migration of embedded 
pellets can involve the urological tract several months after the ini-
tial injury. 
 
Jessica Louise Macwilliam, Rahul Mistry, Michael St John Floyd Jr

Delayed Ureteral Obstruction Following 
Gunshot Pellet Migration

REFERENCES
1. Bulut K, Kukul E, Ogus M, Guntekin E. An unusual case of ureteric colic. Br J Urol. 1998;82:148-9.

2. Gawande AS, Kinnard PD, Stanley EH. Ureteric colic due to migrating shotgun pellet. Br J Urol. 
1982;54:191.

3. Kumar Pal D. Spontaneous passage of shotgun pellets during voiding. Br J Urol. 1998;81:498.

PICTORIAL  UROLOGY

A

B

C

Figure 1. Com-
puted tomography 
scan showing 
multiple intra-
abdominal radio-
opaque pellets and 
a proximal ureteral 
pellet causing ob-
struction with peri-
ureteral and renal 
fat stranding (A).

Figure 2. Plain 
abdominal x-ray 
showing radio-
opaque pellets 
and indwelling left 
nephrostomy (B).

Figure 3. Ante-
grade pyelogram 
showing a proxi-
mal obstructing 
left ureteral pellet 
(C).