What should be Done with this Bullet

by

Jon Dudley Dorman, M.D.

36 year old Somali woman was struck by shrapnel in 1994 in the civil war conflict of her country. An entry wound lies over the left sacroiliac joint. Immediately she was paralyzed in the right leg, but slowly became able to walk. She has gained weight up to 150 kilos, and in the last year, the right leg has become weaker and more painful. She won't squat for fear of being unable to rise up. The right quadriceps and hamstrings are 4/5, R ankle and toe extension 3/5, plantar flexion 3/5, foot eversion 1/5. No vibratory sensation to 256 tuning fork in the four small toes, present in the large toe. Sensation and strength normal on the left.

After you observe where the bullet lies, would you operate or let it be?