PMC10365913_01
(Radiographs) Left lateral radiograph of the abdomen (a), left lateral radiograph of the abdomen with the hind limbs flexed forward (b), and ventrodorsal radiographs of the pelvis (c). Panels (a, b) were taken on initial intake, with panels (c, d) taken later during further workup. There are two pellets superimposed with the caudal abdomen on the lateral view. One pellet is noted superimposed with the thigh musculature of the right hind limb on the ventrodorsal projection (#). However, the second one remains in the plane of the urethra on all 3 projections (*). Lateral radiograph of the abdomen. The pellets that were noted on the plain radiographs remain visible (# and *). A positive cystogram (d) was initially performed through the cystotomy tube (>). Subsequently, a urethrogram was performed (D), and the urethra is maintained clamped (^). The urethra is filled with positive contrast up to the point of the pellet (*), but no contrast is extending past the urethra.
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fig1
After the procedure, while the patient was under general anesthesia, contrast normograde and retrograde cystourethrograms were performed, revealing the obstruction to be in the patient's pelvic urethra (Figure 1). The two metal-opaque ballistic foreign bodies present on the preoperative radiographs were also identified during the cystourethrogram (Figure 1). One ballistic foreign body was identified in the distal pelvic urethra in the perineal region on both orthogonal radiographs and confirmed to be within the lumen of the urethra on ultrasound, with the second noted to be superficial in the hip region (Figures 1 and 2).
(Ultrasound) Longitudinal image of the perineal urethra ((a) nonannotated, (b) annotated image). The proximal aspect of the urethra is on the left of the image. On the annotated image (b), the urethra is moderately distended (*) just proximal to the pellet (contoured).
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fig2
One ballistic foreign body was identified in the distal pelvic urethra in the perineal region on both orthogonal radiographs and confirmed to be within the lumen of the urethra on ultrasound, with the second noted to be superficial in the hip region (Figures 1 and 2).
(Skin images and corresponding radiographic locations): (a) Lateral radiograph identifying pellet obstructing urethra (blue star), and pellet in the hip region (yellow circle). The blue circle in (a) corresponds to the scar noted in (b) over the paralumbar fossa. The scar highlighted in 3C is in the immediate region of the pellet in the hip region.
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fig3
One scar was identified in proximity to the pellet over the hip, and another scar was identified in the paralumbar fossa (Figure 3, with corresponding radiographic locations).
The projectile pellet was recovered from the urethra of the patient. Note the cone-shaped base and rounded tip, without evidence of deformation. The diameter (not pictured) was measured to be 4.5 mm.
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fig4
Using the Kelly hemostatic forceps, the pellet (Figure 4) was grasped and removed from the urethra.