Imagine the shock of realizing you've accidentally gulped down a metallic bullet casing mid-meal – a heart-pounding scenario that could turn a simple dinner into a medical emergency. But what if the body just handles it naturally, without any invasive procedures? This real-life case of a teenager who swallowed such an object and had it pass through safely challenges our ideas about when to intervene. Dive in, because the details might surprise you!
Spontaneous Expulsion of a Mistakenly Ingested Metallic Bullet Shell in a Young Teen: A Detailed Case Study
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- Released on November 5, 2025
International Journal of Emergency Medicine (https://intjem.biomedcentral.com/) Volume 18, Article Number: 229 (2025) Cite this article
Summary
Context
Unintended swallowing of odd objects often brings people to the emergency room and can trigger grave issues. This usually affects kids and high-risk grown-ups, but it's uncommon in fit teenagers who lack any underlying conditions.
Patient Story
We detail the experience of a 17-year-old girl who unknowingly swallowed a metallic bullet casing while eating. She arrived at the hospital just two hours later, complaining only of a slight throat irritation. Repeated belly X-rays showed the casing moving steadily through her digestive system without causing tears or blockages. With attentive hospital watch, including regular check-ups and imaging, the object exited naturally via the rectum. She stayed symptom-free, and later check-ins confirmed no lasting problems.
Analysis
Typically, small, rounded foreign items exit on their own. This example shows that, for selected symptom-free patients, watchful waiting without surgery is a reliable and successful strategy.
Key Takeaway
Watchful care works well for healthy teens who accidentally ingest items, as long as no signs of blockage, tears, or other troubles appear.
Introduction
Swallowing foreign objects is a frequent issue in emergency care, contributing to notable health burdens and roughly 1,500 fatalities each year in the US [1 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR1)]. It's most common in children, and in adults with factors like heavy drinking, missing teeth, mental health issues, or digestive problems [1 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR1), 2 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR2)]. In grown-ups, conditions such as narrow spots (around 37%), tumors (10%), esophageal bands (6%), and achalasia (2%) often play a role [3 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR3)]. While rare in teens, such mishaps can still happen to healthy folks with no risk elements.
Imaging plays a vital role in both spotting and handling these cases. Although CT scans provide richer details, especially for suspected tears, simple X-rays are commonly used to spot and track ingested items [4 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR4)]. Endoscopic or surgical removal is for risky cases, like sharp objects, batteries, magnets, or oversized items, but most small, blunt, smooth ones pass by themselves [5 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR5), 6 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR6)].
Here, we share a unique story of a teen who unintentionally swallowed a bullet casing and was managed conservatively. This case underscores the importance of careful patient choice and vigilant monitoring for positive results.
Patient Story
A 17-year-old girl came to the ER two hours after inadvertently swallowing a long metallic bullet casing during her evening meal. She mentioned being engrossed in her phone when she felt a hard, metallic object go down her throat. She reported no stomach pain, nausea, throwing up, bleeding from the rectum, choking, coughing, chest discomfort, or breathing difficulties, but did note mild throat soreness. Her personal, surgical, mental health, and family histories were clear, and she denied any substance use.
Upon check-up, her vital signs were steady. No issues with her teeth, and chest, belly, and rectal exams were normal. Blood tests came back fine.
Three hours after ingestion, a standing belly X-ray revealed a dense, elongated bullet casing tilted in the left lower belly area, likely in the end of the small intestine (Fig.1 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#Fig1) A). No X-ray or symptom clues of a tear, and she was stable. Admitted to the surgical unit, she received close supervision with follow-up scans, vital sign checks, and repeated belly exams.
Series of belly X-rays traced the bullet casing's journey through the digestive system, moving from the terminal ileum (A), to the upper right colon (B), to the lower left colon (C), and into the rectum (D).
Full size image (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3/figures/1)
An X-ray 11 hours later showed it had shifted to the right lower belly, matching the upper right colon (Fig.1 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#Fig1) B). At 22 hours, it progressed to the lower left colon (Fig.1 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#Fig1) C). By 28 hours, it was in the rectum (Fig.1 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#Fig1) D).
Even though it reached the rectum, a contrast-enhanced CT scan of the belly and pelvis was done at 39 hours to pinpoint its position and rule out issues like tissue damage or tears. CT with contrast is recommended when complications like blockages, tears, or object shifts are suspected, or if the item doesn't show on plain X-rays due to being see-through. Axial and side-view pelvic CT images showed the casing stuck in the lower rectum, with no air leaks, tears, or blockages (Fig.2 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#Fig2) A&B).
Axial (A) and sagittal (B) belly and pelvic CT scans show the bullet casing in the lower rectum, with no signs of bowel tears.
Full size image (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3/figures/2)
At 49 hours, she naturally passed the bullet casing through the rectum without help (Fig.3 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#Fig3)). Over the next 24 hours in the hospital, she showed no symptoms, and her vital signs and belly checks remained normal.
The passed metallic bullet casing, about 2.5 cm by 0.7 cm, Y-shaped, exited on its own via the rectum.
Full size image (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3/figures/3)
She left the hospital in good shape and returned to the surgical clinic six weeks later for a check-up, which was clear. A phone follow-up six months after confirmed full recovery and normal activities, with no issues.
Discussion
Ingestion of foreign objects is a common medical challenge that can sometimes be deadly [1 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR1)]. In the US, about 120,000 cases are reported yearly, mostly in kids aged 6 months to 3 years [7 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR7)]. Adults at higher risk include those intoxicated, with serious mental health conditions, intellectual challenges, or seeking attention, like in prisons [8 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR8)]. Accidental big swallows also happen in seniors, especially toothless ones who struggle with tough foods. These folks often have background issues like narrowings, cancers, achalasia, or esophageal bands that make swallowing hard [2 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR2), 9 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR9)].
Symptoms depend on the object's type, location, and how long it's stuck. Some people have no signs, others get belly pain, nausea, vomiting, blood in vomit, rectal bleeding, fever, or diarrhea [10 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR10)]. Our patient was a healthy teen with no risks, her only sign being brief throat irritation after swallowing the casing.
X-rays are the go-to for spotting dense foreign bodies, revealing size, count, spot, angle, shape, and sharp edges [4 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR4), 11 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR11)]. They track movement and can spot air leaks from tears. But tiny or see-through items, like thin metals, wood, or glass, might not show [12 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR12)]. Fish bones in tight spots cause most digestive tears, with up to 83% hitting the ileum [13 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR13)].
Management depends on stability, complications, object type, and location. Sharp items, batteries, and high-risk cases need endoscopic or surgical removal to prevent tears, bleeding, or infections [6 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR6), 14 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR14), 15 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR15)]. Blunt objects under 6 cm long or 2.5 cm wide usually pass naturally, so watchful waiting is best [16 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR16)]. Stuck in the upper gut or not leaving the stomach in a week, especially at spots like the ileocecal junction, may need action [1 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR1), 17 (https://intjem.biomedcentral.com/articles/10.1186/s12245-025-01047-3#ref-CR17)].
Our case proves conservative care with scans and regular checks can be safe for symptom-free adults without developmental or mental issues. These patients can report new symptoms for quick fixes. Careful selection, detailed histories, constant monitoring, and low thresholds for escalation are key to conservative approaches.
And this is the part most people miss – is conservative management always the safest bet, or could it risk complications if the object lingers too long? But here's where it gets controversial: Some might argue that immediate removal prevents any chance of issues, even in low-risk cases, sparking debate on balancing risks.
Conclusion
For those who accidentally swallow items like bullet casings, doctors should balance the benefits of careful, non-invasive care against urgent actions. Advanced scans or surgeries are reserved for specific needs, while basic X-rays remain a handy, non-invasive way to find and follow dense objects. Ongoing clinical checks, based on full histories and exams, are vital to catch problems early and tailor safe, personalized plans.
What do you think? Should we always opt for watchful waiting in such cases, or does this case prove it's worth the gamble? Do you agree that healthy teens are ideal for conservative approaches, or is there a counterpoint here? Share your views and debates in the comments below – we'd love to hear from you!
Data Availability
The supporting data for this study can be found in the Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital system. However, access is granted to the authors upon reasonable request and with approval from the education and research committee.
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Funding
We confirm no funding sources were involved.
Author Information
Authors and Affiliations
1.
Department of Emergency Medicine, Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Digfer Road, Hodon, Mogadishu, Somalia
Sowdo Nur Iyow,Abdullahi Ahmed Ahmed&Hassan Adan Ali Adan
2.
Department of General Surgery, Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Mogadıshu, Somalia
Abdulkadir Nur Mohamed
3.
Department of Radiology, Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Mogadıshu, Somalia
Shuayb Moallim Ali Jama
Authors
- Sowdo Nur Iyow
- Abdullahi Ahmed Ahmed
- Abdulkadir Nur Mohamed
- Shuayb Moallim Ali Jama
- Hassan Adan Ali Adan
Contributions
SNI: handled project management, methods, and initial writing. AAA: managed data, project, writing, and oversight. ANM helped with ideas and writing. SMAJ: analyzed images and data. HAAA: led ideas, revisions, and overall guidance. All authors reviewed, approved the final manuscript, agreed on submission, and take responsibility.
Corresponding Author
Correspondence to Abdullahi Ahmed Ahmed.
Ethics Statements
Ethical Approval
The Institutional Review Board (IRB) of Mogadishu Somali Turkiye Training and Research Hospital (MSTH) does not require approval for single-patient case reports.
Informed Consent for Publication
Written consent for sharing details and images was obtained from the patient's parents.
Competing Interests
The authors declare no conflicts.
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Nur Iyow, S., Ahmed Ahmed, A., Nur Mohamed, A. et al. Spontaneous passage of an accidentally ingested metallic bullet casing in an adolescent: a case report. Int J Emerg Med 18, 229 (2025). https://doi.org/10.1186/s12245-025-01047-3
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Received: 13 May 2025
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Accepted: 28 October 2025
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Published: 05 November 2025
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Version of record: 05 November 2025
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DOI: https://doi.org/10.1186/s12245-025-01047-3
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