Lead poisoning presents with variable symptoms, ranging from asymptomatic cases to significant neurological deficits. This report describes a 39-year-old male with chronic symptoms, including abdominal pain, back pain, and mood changes, 12 years after sustaining a gunshot wound to the thigh with retained bullet fragments. Preoperative serum lead levels were mildly elevated at 5.3 µg/dL. Surgical removal of major bullet fragments was performed with fluoroscopic guidance, minimizing tissue trauma. Postoperatively, the patient experienced substantial improvement in symptoms suspected to be caused by lead exposure, including resolution of abdominal pain and fatigue. Serum lead levels gradually declined to 4.4 µg/dL at seven months post-surgery. This case demonstrates the potential benefits of surgical intervention for retained lead fragments when symptoms are suspected to result from lead toxicity. The intervention led to improvement of the patient’s symptoms and reduced serum lead levels. Further research is warranted to establish guidelines for the optimal management of retained bullet fragments, balancing surgical risks with potential clinical benefits.
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