KGMU Neurosurgeons Triumph Over Rare Migratory Bullet in Toddler's Brain
In a remarkable medical achievement, doctors at Lucknow's prestigious King George's Medical University (KGMU) have successfully managed an exceptionally rare and complex case involving a migratory bullet that kept moving inside the brain of a three-year-old child. The incident, which began on December 16, presented unprecedented challenges to the neurosurgical team as the projectile traveled through critical brain regions over an extended period.
The Fateful Incident and Initial Assessment
The young patient, identified as Lakshmi, was playing on her rooftop in Lucknow's Indiranagar neighborhood when a stray bullet struck her on the evening of December 16. She was initially taken to a nearby private hospital before being referred to KGMU as her condition progressively deteriorated. Dr. Ankur Bajaj of KGMU's neurosurgery department, who led the surgical intervention, explained that the injury represented a penetrating head injury, where the bullet entered through the left frontal bone near the forehead and traveled into the brain tissue.
The Dangerous Migration of the Projectile
The case became particularly challenging due to the bullet's unexpected movement within the child's brain. A CT scan conducted approximately four and a half hours after the incident showed the bullet positioned near the front surface of the brain. However, when the child arrived at KGMU the following day, a repeat CT scan performed nearly 20 hours post-injury revealed that the projectile had migrated deep into the basal region of the brain.
"This movement was extremely dangerous as this area controls vital functions like breathing, movement, and consciousness," emphasized Dr. Bajaj. Medical professionals were particularly concerned about potential damage to major blood vessels, which could have triggered life-threatening bleeding. To evaluate this risk, they planned a CT angiography to study the blood vessels in detail.
In another surprising development, the CT angiography conducted about 25 hours after the initial injury showed that the bullet had moved yet again, this time to the occipital region at the back of the brain, which governs visual functions. This confirmed that doctors were dealing with a migratory or "wandering" bullet inside the brain—a phenomenon considered exceptionally rare worldwide, especially in pediatric patients.
Clinical Presentation and Surgical Decision
Upon admission to KGMU, the child exhibited drowsiness and right-sided hemiparesis (weakness on the right side of the body). As the bullet continued to shift position and the child's neurological condition worsened, the medical team made the critical decision to perform urgent surgical intervention. The constantly changing location of the bullet presented one of the primary surgical challenges.
The Innovative Surgical Approach
Dr. Bajaj, along with colleagues Dr. Anoop K Singh, Dr. Ankan Basu, and Dr. Shraddha, conducted the operation under the guidance of Prof. B K Ojha, head of the neurosurgery department. To overcome the challenge of the moving projectile, surgeons employed intraoperative fluoroscopy, which provides live X-ray imaging during the procedure.
"This technology helped us locate the bullet in real time and remove it safely without damaging surrounding brain tissue," explained Dr. Bajaj. The anesthesia team, led by Dr. Monica Kohli and Dr. Neelkamal, played a crucial role in maintaining the child's stability throughout this high-risk procedure.
Remarkable Recovery and Institutional Recognition
Following the successful surgery, the child demonstrated clear signs of improvement. "The child is now more alert and can hold objects with the previously weak hand, indicating recovery of brain function," reported Dr. Bajaj with evident satisfaction. Prof. Sonia Nityanand, vice-chancellor of KGMU, congratulated the medical team for their exceptional management of this rare case and praised their clinical expertise and teamwork.
The child's parents, who come from an economically disadvantaged background, expressed profound gratitude to the doctors, describing the outcome as a "miracle that brought their girl back to them." This case highlights both the advanced capabilities of India's medical institutions and the resilience of young patients facing extraordinary medical challenges.
