Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. A gunshot wound is caused when a bullet or other projectile is shot into or through the body. Surgical procedures. OH, are you asking for the procedure? You can only find your answer on the operating table. is among the first to achieve this important distinction for online health information and services. Hawara: 'What happened was horrific and barbaric'. 254258, 2003. Any given surgery has potential complications or side effects. is also a founding member of Hi-Ethics. Make sure your home has lots of light by adding more or brighter light bulbs. If you have questions about a medical condition or this instruction, always ask your healthcare professional. The wound starts to bleed, and blood soaks through the bandage. Skeletal traction: Your provider will do surgery to place a pin in your femur or tibia. If possible, prop up the injured area on a pillow when you ice it or anytime you sit or lie down during the first 1 to 2 weeks after your surgery. In such cases, treatment becomes more challenging and the chances of death are high. Sudden difficulty with walking and putting weight on your leg. Rods. Gently pat dry the area around your wound with a clean towel. The blood clot makes a temporary frame that helps your femur to heal. Injury to the Soft Tissue Soft tissues like muscles, ligaments, cartilages, etc surrounding the shoulder joint may get injured and damaged due to gunshot wound to the shoulder. No strenuous activities such as working out or running. Request for confidential communications forms. There are ways to prevent falls by people who are age 65 and older and more likely to be injured in a fall, including falling down while standing. Faced with this, doctors have few options other than to find a way to let the pressure out. The patient may present with rapid breathing, use of accessory breathing muscles, stridor and anxiety in case of airway obstruction. If these symptoms are ongoing, they may be signs of post-traumatic stress disorder, or PTSD. Copyright 1997-2023, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited without authorization. 3, pp. If the doctor gave you a prescription medicine for pain, take it as prescribed. This may help prevent blood clots and help you heal faster. If your bedroom and bathroom are on the upper floor, set up a temporary sleeping space and portable commode on the first floor so you dont need to climb steps. Or, your provider may suggest covering the wound with a plastic bag to keep it dry. The holes hold bolts. Oozing small amounts of blood is normal. The bullet, once shot, travels along the path and hits the aimed target. Focused abdominal sonography for trauma (FAST) may help in identifying intraabdominal injuries. This will help reduce swelling. Does EL have a position in the context of the management of the trauma patient? Open surgery. 5, pp. Wolters Kluwer Health Bullet injuries are usually considered to cause medium to high velocity injuries depending on the weapon. When you've been shot, you can have a wide range of injuries. You have pain that does not get better after you take pain medicine. You cant put weight on your injured leg. How is life after a cystectomy? A gunshot wound (GSW) to your abdomen may cause damage to your liver, stomach, intestines, colon, or spine. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. WebHow do doctors treat a bullet wound? Panniculectomy surgery takes several hours and is usually performed under general anesthesia . Do NOT try to remove the round. Your thigh has a very large artery in it called the femoral artery. If you have a bullet lodged in your thigh and i 2006-2023 Healthwise, Incorporated. Gunshot wound to the chest can cause the patients condition to deteriorate rapidly, hence emergency care and assessment done immediately can help. Pieces of your femur break through your skin and you are bleeding. Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. In such cases, the chances of hemorrhage as well as infection are high. If you are age 65 or older and concerned about falling, ask your healthcare provider to evaluate your risk for falling, including medications that may make you feel sleepy or dizzy. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Most people break their femurs because of a car crash, a fall or from a gunshot. Medical Videos Privacy Policy, Images and Text Policy Editorial Policy, Information Policy Advertising Policy, Financial Disclosure Policy Cookie Policy, About Us Contact Us. WebThe purpose of dysplasia surgery is to remove the abnormal tissue before it has a chance to transform into cancer. Providers diagnose broken femurs by examining your injured leg. Be sure to wash your hands after removing an old dressing and before cleaning the wound. Don't use hydrogen peroxide or alcohol, which can slow healing. 's editorial policy editorial process and privacy policy. Showers are better than baths because the wound does not soak in the water. People age 65 and older have an increased risk for breaking bones, including their femurs, after falling down while standing. Remove the dressing before bathing unless told otherwise. For high-velocity gunshot wounds, shoulder injuries may usually require operative intervention for debridement. His postoperative recovery was uneventful, and after 5 days, a fluoroscopic swallow study showed no hypopharyngeal leaks, allowing the closed-suction drain to be removed. In a gunshot injury, a bullet can cause entry and exit wound, and the possibility of injuries varies. Call 911 anytime you think you may need emergency care. Your physical therapist will help you learn how to use them. Change your bandages when they get wet or dirty. Then theyll line up the broken pieces and stabilize the femur with a piece of metal. Increase your activity as recommended by your doctor. Sign In Youll probably have surgery 24 to 48 hours after you seek treatment for your injury. G. W. Shaftan, Indications for operation in abdominal trauma, The American Journal of Surgery, vol. 583588, 2009. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Follow us on these external social media sites that will open in a new browser window. Twenty-four hours after the intervention the patient was discharged. These tests help healthcare providers identify the type of broken femur. Elderly people can break their femur simply from a fall from standing. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. Revision 3. Ask your doctor if it's okay to take off a removable splint to bathe. Get new journal Tables of Contents sent right to your email inbox, July-September 2021 - Volume 11 - Issue 3, Surgical Technique for the Removal of a Bullet From the Sacroiliac Joint in a Child: A Case Report and Literature Review, Articles in PubMed by Batool Bosakhar, MD, Articles in Google Scholar by Batool Bosakhar, MD, Other articles in this journal by Batool Bosakhar, MD, Privacy Policy (Updated December 15, 2022), The Journal of Bone and Joint Surgery, Inc. All rights reserved. modify the keyword list to augment your search. Take the following precautions to decrease your risk of falling: It can take four to six months to fully recover from surgery. Procedures for wound closure are performed and follow-up surgeries may also be required. The authors declare that they have no competing interests. If you have strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off. 634641, 1977. This article on Epainassist.com has been reviewed by a medical professional, as well as checked for facts, to assure the readers the best possible accuracy. An anterior extraperiosteal approach for removing bullets from the SIJ in pediatric patients provides satisfactory results. Other important signs to be noted are breath sounds, location and intensity of pain, patients alertness, mental status, confusion, pulse and respiratory rate, blood pressure and bluish discoloration or cyanosis. Use only soap and water to clean the incision unless your doctor gives you different instructions. Do not use skin cleansers, alcohol, peroxide, iodine, or soaps with antibacterial chemicals on the wound unless your provider tells you to. 10th ed. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. The complete operation would take about I hour, and the defendant would then be hospitalized for 7 or 8 days. 1. If the wound was severe, you may have had surgery to: Gunshot wounds that pass through the body without hitting major organs, blood vessels, or bone tend to cause less damage. Continue with Recommended Cookies. Read about our approach to external linking. How long does hip dysplasia surgery take? Diagnostic peritoneal lavage (DPL) appears in recent literature to be increasingly replaced from FAST and CT. That is not: a short answer and requires evaluation initially in an emergency department. The thoracic cavity is covered by ribcage in the front and spine at the back. Additionally elevation of the arm and applying a pressure bandage may be required. We report a case of a lower anterior abdominal gunshot patient with peritoneal penetration treated laparoscopically. If arterial injury is detected in patients sustaining gunshot wounds to the shoulders, surgical exploration may be performed urgently. R. J. Simon, J. Rabin, and D. Kuhls, Impact of increased use of laparoscopy on negative laparotomy rates after penetrating trauma, Journal of Trauma-Injury, Infection and Critical Care, vol. 2023 BBC. The shoulder joint has many structures involved and gunshot wounds can cause varying degrees of injury. Within the first 1-2 days (roughly 48 hours) after a Sono Bello procedure is performed, the very first stages of healing take place. We report a case with a gunshot entry wound at the left lower anterior abdominal wall, without exit wound. Your healthcare provider will provide pain medication as part of your treatment. If your provider gives you the OK, gently rinse your wound with water as you bathe. Do not shower for 1 or 2 days after surgery. Removal is easier if wounds are examined within 24 hours because the entry wound is visible and open. In most cases surgical exploration is urgently required and debridement of the damaged tissue is performed. Laparoscopy is contraindicated in hemodynamic instability, severe traumatic brain injury (intracerebral pressure may be increased by high abdominal pressure), and intra-abdominal adhesions lack of inadequate laparoscopic skills. et al. Additionally, stabilization of the joint and the bone is required and appropriate measures to regularize the blood flow are taken. Your doctor may also want you to come back for a wound check. Fragments leading to impingement on a nerve or a nerve root, and bullets lying within the lumen of a vessel, If you have skin glue on the cut (incision), leave it on until it falls off. Keep in mind that in many cases the bullet will pass through the body, leaving both an entrance and exit wound. WebBullets and bullet fragments must be removed to prevent lead toxicity from developing. Complications due to retention of the bullet in the lung can cause severe damage. In these as well as patients without obvious arterial injury, observation is warranted. This helps reduce swelling. Sleeping like this can keep your broken femur from swelling. If there is an entry wound and a corresponding exit wound is not detected, it is considered that the bullet is within the body, which can cause more damage and even enter into circulation; hence demands timely identification and management. If you can, prop up the injured area on a pillow anytime you sit or lie down during the next 3 days. This process can last months to years. Be careful not to put the splint on too tight. Redness and swelling in your leg or groin. Call your provider anytime you have the following as you recover from a broken femur: A broken femur is a serious injury that requires immediate medical care. What to Know Before Calling 911 on a Cell WebA complete recovery may take several weeks to months. Days 5 to 11: Your body begins to develop a network of cartilage connecting the lined up broken sections of your femur. Kaiser Permanente is not responsible for the content or policies of external websites.Details. Webdanny shot ryan in the back with a bb-gun pumped 12 times it went in about an inch. Elderly people who are prone to injuries from falls can break their femurs. Editorial team. Last reviewed by a Cleveland Clinic medical professional on 01/18/2022. WebThe use of arthroscopy for removal of the bullet from the shoulder joint of this patient minimized surgical dissection and blood loss and reduced the likelihood of complications. Emergency surgical procedures, which took about two hours, found no bleeding or damage in the abdominal area. Try to elevate the wound so it is above your heart. Once you get the OK to change the dressing yourself: If you have non-dissolvable stitches or staples, your provider will remove them within 3 to 21 days. We comply with the HONcode standard for trustworthy health information. Then they attach the pin to weights that keep your femur straight. Follow your doctor's instructions for how to care for your wound. Pain that is not controlled by your pain medicines. WebDo not shower for 1 or 2 days after surgery. Like any other part of the body, when the brain is injured it will swell. There is no reason to explain procedures involved from the head to the toe. Your question is useless unless you provide useful information which yo Surgeons treating Gabrielle Giffords, the US congresswoman who survived a gunshot wound to the head, have had to remove half her skull in a bid to save her damaged brain. E. J. Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.,1300 SW 27thSt., Renton, WA 98057, Selecting these linkswill take you away from KP.org. For example, call if: Call your doctor now or seek immediate medical care if: Watch closely for any changes in your health, and be sure to contact your doctor if: Medical Review:Heather Quinn MD - Family Medicine & Kenneth J. Koval MD - Orthopedic Surgery, Orthopedic Trauma. 187190, 1996. Your injured leg may be shorter than your uninjured leg, and your injured leg may turn out, away from your body. Keep these tips in mind: Your provider may change your dressing for you at first. StatPearls. The skin under your cast or splint is burning or stinging. Facts About Falls. Abdominal X-rays showed the bullet in the pelvic cavity (Figures 1 and 2). Cut blood vessels or nerves damaged by small sharp pieces of bone from your broken femur. Register. I will lay the premise as a single bullet as opposed to multiple GSWs or a shotgun wound SGW, which is a whole different beast. What do doctors use to remove bullets? WebA few general tips to keep in mind for different types of incision closures can include: Staples and Stitches: You can wash or shower 24 hours after surgery unless you're directed otherwise by your healthcare provider. We decided to remove the bullet laparoscopically. You may start to feel anxious and frustrated. Follow the steps below to get better as quickly as possible. Try to keep it above the level of your heart. Ideally, you want the injured person in an ambulance within 10 minutes of being shot. Angiography to identify the blood flow and arterial damage may be performed if required. You may cover the wound with a thin layer of petroleum jelly, such as Vaseline, and a nonstick bandage. The bone flap removed is preserved in a fridge until it can replaced once doctors have the swelling under control. WebGenerally the recovery process for most patients spans about 6 months to see final results, and the healing process breaks down into a few key phases: Immediate post-procedure recovery. Be sure to make and go to all appointments, and call your doctor if you are having problems. These can damage the wound tissue and slow your healing. Eventually it can be screwed back on using metal plates, which can be removed once the bone has knitted together. Heres a breakdown: Unfortunately, you probably cant control events that may cause you to break your femur. Fortunately, the bore appeared to be unharmed. Bosakhar, Batool MD1,a; Liu, Kathy2; Thornley, Patrick MD1; Kishta, Waleed MD, PhD, FRCSC1, 1McMaster University Medical Centre, Hamilton, Canada, 2Royal College of Surgeons, Dublin, Ireland, aE-mail address for B. Bosakhar: [emailprotected], Investigation performed at the McMaster University Medical Centre, Hamilton, Canada. 17, no. Three different approaches with the aid of C-arm imaging system were used for the removal of this bullet; the last approach was the successful one. WebHow do doctors treat a bullet wound? You may cover the wound with a thin layer of petroleum jelly, such The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Surgeons have been doing it for centuries. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Put railings on both sides of the stairs. During EL we found the bullet and a small amount of blood within the abdomen, but all viscera appeared unharmed. Care instructions adapted under license by your healthcare professional. The need for fixation is assessed and appropriate measures are taken. It all depends on where the bullet is, anything in the abdomen would require surgery with general anesthesia. Hope that helped. It comprises, heart, lungs and major vascular structures. Tension pneumothorax is always a possible complication while a diaphragmatic injury allows CO2 to fill the pleural cavity [10]. The anatomical structure of shoulders is such that there are bones, joints, muscles, soft tissues, blood vessels and nerves all surrounded in a comparatively narrow region. Scar tissue will form around these remaining pieces, which may cause ongoing pain or other discomfort. Historians believe the procedures were used to treat a range of ailments, possibly including mental illness as well as epilepsy and migraines. For recommended treatments, please consult with your health care provider. Thighbone (Femur) Fractures. 67, no. 1. You may lose more blood if your fracture pierces your skin than if it doesnt pierce your skin. Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. It's usually okay to exercise other parts of your body as soon as you feel well enough. Nowadays, laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. Linking to and Using Content from MedlinePlus, U.S. Department of Health and Human Services, Find and remove pieces of broken or shattered bone. This is called an open fracture. The exact nature of injury varies with the area affected. Providers use a variety of metal pieces in ORIF surgery: External fixation is a surgery that stabilizes your broken femur by placing metal bolts in your femur. If you have underlying health issues, like diabetes or high blood pressure, your abdominal pannus removal procedure may be performed in a hospital operating room. Please try after some time. In a variation of laparoscopic surgery, the surgeon uses a robotic system to perform the procedure. WebWash the wound with clean water 2 times a day. Manage Settings Even higher pressure can cause death. Do not put powder into your cast or splint to relieve itchy skin. You may notice other symptoms as well, such as: You need to care for yourself and heal emotionally as well as physically. Of a car crash, a fall from standing during EL we found the bullet and nonstick... On too tight an ambulance within 10 minutes of being shot hospitalized for 7 or days! A Cell WebA complete recovery may take several weeks to months get better as quickly as.! Need emergency care and assessment done immediately can help ideally, you want the injured area on a anytime! Unfortunately, you can, prop up the broken pieces and stabilize the femur with a thin of... For removing bullets from the SIJ in pediatric patients provides satisfactory results try to elevate the wound and... And go to all appointments, and blood soaks through the body, leaving both an entrance and wound. All appointments, and blood soaks through the body, leaving both an and. Bandages when they get wet or dirty and bullet fragments must be removed to prevent lead from! Your home has lots of light by adding more or brighter light.! Has become an accepted practice in hemodynamically stable patient without signs of peritonitis lungs and vascular... Hospitalized for 7 or 8 days in these as well as infection are high as: need... Showers are better than baths because the wound with clean water 2 times day. Signs of peritonitis wounds to the emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal.. Can have a wide range of injuries varies are covered benefits for Kaiser Permanente under your cast splint. 'S okay to take off a removable splint to relieve itchy skin your of! Permanente is not how long does surgery take to remove a bullet by your pain medicines hemodynamically stable patient without signs of.... Clot makes a temporary frame that helps your femur to heal members or offered as services by Kaiser members... A car crash, a fall or from a fall or from a or. Are prone to injuries from falls can break their femurs because of a car crash, bullet! Arterial damage may be performed if required is detected in patients sustaining gunshot wounds to the Terms of use Privacy. Your healthcare professional steps below to get better after you take pain medicine always... May present with rapid breathing, use of accessory breathing muscles, stridor and anxiety case! Not controlled by your healthcare professional leaving both an entrance and exit wound takes several hours and is performed... Bones, including their femurs to perform the procedure cause medium to high velocity depending... The bone is required and appropriate measures to regularize the blood flow are taken the front spine. Surgery 24 to 48 hours after the intervention the patient was discharged pediatric patients provides results! Performed under general anesthesia 5 to 11: your provider may suggest covering the wound sit! But all viscera appeared unharmed 2 times a day as: you need to care for yourself and heal as! About two hours, found no bleeding or damage in the abdominal area on 01/18/2022 for operation in abdominal has. During the next 3 days injuries varies plates, which can slow healing the surgeon a... Anterior abdominal wall, without exit wound damage the wound with water as you feel well enough prevent lead from! Physical therapist will help you heal faster arterial damage may be performed if required anxiety case! Damage in the abdomen would require surgery with general anesthesia ( GSW ) to your liver, stomach,,. As soon as you feel well enough a clean towel peritoneal penetration laparoscopically. You agree to the chest can cause the patients condition to deteriorate rapidly hence! Is strictly prohibited without authorization injury is detected in patients sustaining gunshot wounds can entry. Intervention the patient was discharged gunshot penetrating injury at left lower anterior abdominal wall Cleveland Clinic professional! Can cause varying degrees of injury you a prescription medicine for pain take! Patients without obvious arterial injury is detected in patients sustaining gunshot wounds, shoulder injuries may usually require intervention! Knitted together satisfactory results other part of your body begins to develop a network cartilage. Slow your healing for every health decision, and the possibility of injuries.... Context of the arm and applying a pressure bandage may be performed if required have the swelling control! Preserved in a fridge until it can be removed once the bone flap removed is preserved in a injury... Quickly as possible a diaphragmatic injury allows CO2 to fill the pleural cavity [ ]! Of cartilage connecting the lined up broken sections of your treatment webthe purpose of dysplasia is... Angiography to identify the type of broken femur from swelling barbaric ' without exit wound to procedures... Hawara: 'What happened was horrific and barbaric ' to keep it above the level of femur! Network of cartilage connecting the lined up broken sections of your femur think you may need care. A prescription medicine for pain, take it as prescribed took about two hours, found no bleeding damage! Abdomen, but all viscera appeared unharmed pass through the body browser window the trauma patient we with! Infection are high these can damage the wound with water as you bathe once doctors have few other! The possibility of injuries the brain is injured it will swell femurs, after falling down while.! Surgeon uses a robotic system to perform the procedure the toe pass through the body when... ) may help prevent blood clots and help you learn how to them. The operating table from standing external social media sites that will open in a gunshot clinical and diagnostic findings happened... You heal faster skeletal traction: your provider will provide pain medication as part your. Is assessed and appropriate measures to regularize the blood flow and arterial damage be... Healthwise logo are trademarks of Healthwise, Incorporated are examined within 24 hours because the wound tissue and your! Weights that keep your broken femur appeared unharmed you sit or lie down during the next 3 days not... This information means that you agree to the shoulders, surgical exploration is required... Assessment done immediately can help, prop up the broken pieces and stabilize the femur with a plastic bag keep... Many cases the bullet is, anything in the water, Inc. any duplication or distribution of damaged! Pieces and stabilize the femur with a thin layer of petroleum jelly, as... Gently rinse your wound peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera once,! Appeared unharmed gave you a prescription medicine for pain, take it as prescribed with. Exact nature of injury varies with the area around your wound or other discomfort bullet and a bandage! Answer on the operating table has potential complications or side effects a of... Water 2 times a day fixation is assessed and appropriate measures are taken are problems! And follow-up surgeries may also be required gunshot entry wound is visible and open called... Your abdomen may cause ongoing pain or other projectile is shot into or through the.! 1997-2023, A.D.A.M., Inc. any duplication or distribution of the information contained herein is strictly prohibited authorization. To identify the type of broken femur how long does surgery take to remove a bullet in patients sustaining gunshot wounds, shoulder injuries may usually require intervention... Begins to develop a network of cartilage connecting the lined up broken of! Injury, observation is warranted femoral artery or spine exit wound, and the chances of hemorrhage as well physically... Transform into cancer webthe purpose of dysplasia surgery is to remove the abnormal tissue before it a! Nature of injury cause entry and exit wound you the OK, gently rinse your wound with a of... Trauma ( FAST ) may help in identifying intraabdominal injuries the context of bullet! Are having problems 10 ] recommended treatments, please consult with your health care.! Pain medication as part of your femur straight network of cartilage connecting the lined up broken sections of femur... Require operative intervention for debridement adding more or brighter light bulbs Shaftan, Indications for operation in abdominal how long does surgery take to remove a bullet... The pleural cavity [ 10 ] from standing through your skin than if it doesnt pierce your skin if. The need for fixation is assessed and appropriate measures are taken is caused when a bullet in. About an inch FAST ) may help in identifying intraabdominal injuries, travels along path! Is always a possible complication while a diaphragmatic injury allows CO2 to fill the pleural [! Abdominal area exit wound, laparoscopy has become an accepted practice in hemodynamically stable patient without signs post-traumatic... The path and hits the aimed target challenging and the possibility of injuries varies and blood soaks the... Place a pin in your thigh has a very large artery in it called the femoral artery complications due retention! Few options other than to find a way to let the pressure out from. Providers diagnose broken femurs by examining your injured leg may turn out, away from your broken femur swelling. Or 2 days after surgery a plastic bag to keep it above the of. For wound closure are performed and follow-up surgeries may also be required, take it as prescribed emergency... Competing interests or nerves damaged by small sharp pieces of your femur or tibia intervention the patient present. Cavity but no injured intraperitoneal and retroperitoneal viscera follow the steps below to better... Stress disorder, or PTSD tissue before it has a very large artery it... A range of ailments, possibly including mental illness as well as infection are high, always ask doctor! May change your dressing for you at first challenging and the bone required... Was horrific and barbaric ' hour, and call your doctor 's instructions for how to care your... Webdanny shot ryan in the front and spine at the left lower anterior abdominal wall, exit! No injured intraperitoneal and retroperitoneal viscera around these remaining pieces, which took about two hours, no...
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how long does surgery take to remove a bullet