A Decade-Long Delay in Presentation of Retained Foreign Bodies as Sequelae of Ballistic Injuries: A Report of Two Cases.

In many regions of the world, ballistic injuries are on the decline. With the reduced incidence of encountering these injuries, there is no general consensus on how to deal with ballistic fragments. Constant research in material science has led to the evolution of materials utilised in ballistics production. However, there has not been enough research into the effect of long-term exposure of the human body to these materials. Ballistic fragments, when asymptomatic and not in the vicinity of vital structures, are often thought to be innocuous in nature. Earlier concepts stated that these metallic fragments were encapsulated in the body by fibrosis and remained inert substances. However, the emerging evidence suggests that these retained ballistic fragments are more alike to ticking time bombs than the inert materials they were earlier thought to be. Side effects of long-term exposure to these materials can lead to not just systemic toxicity due to chronic metallic exposure but may even have carcinogenic effects. This article reports two cases of retained ballistic fragments that presented in a delayed fashion due to their prior asymptomatic status coupled with inadequate investigation and intervention. It also discusses the issues associated with the retention of these fragments, especially in cases where adequate information is not available regarding the nature and composition of the retained materials or their interactions with the human body on long-term exposure.