Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons

In summary, there are only a few clear indications for bullet removal. These include bullets found in joints, CSF, or the globe of the eye. Fragments leading to impingement on a nerve or a nerve root, and bullets lying within the lumen of a vessel, resulting in a risk of ischemia or embolization, should be removed. Rare indications are lead poisoning caused by a fragment, and removal that is required for a medico-legal examination. In all other cases the indication should be critically reviewed.  T. Dienstknecht, K. Horst, R. M. Sellei, A. Berner, M. Nerlich and T. C. Hardcastle. European Journal of Trauma and Emergency Surgery. Online First Dec 2011