Last Friday, on the Muslim holiday of Eid al-Adha, in the Jerusalem neighborhood of Ras al-Amud, a stray bullet hit a 9-year-old boy in the head. Rushed to Hadassah Hospital Ein Kerem, the boy was given a CT scan, which showed that a 3/4-inch bullet had penetrated the right side of his skull. It tore a path through his brain and lodged just inside the skull’s left side.

When the surgeon looked for the bullet, though, it wasn’t where the scan showed it to be.

“We turned the boy onto his stomach to give us the best access to the left side of his head,” explains senior pediatric neurosurgeon Dr. Guy Elor. “But when we began exploring, we could see exactly where the bullet should have been, but it wasn’t there. It seems that when we turned him, gravity took over.”

With the help of an ultrasound and X-rays, Hadassah’s surgical team discovered that the bullet had receded several inches into the boy’s brain, implanting itself in the occipital lobe, which includes the visual cortex. The bullet had traveled through parts of the brain responsible for motor skills, behavior, and higher thought, just missing major arteries and veins by a 10th of an inch.

Once the Hadassah surgeons found the bullet, they delicately lifted it out with a bayonet tweezer.

Anesthesiologist Dr. Chloe Mimouni, emphasizing that working with a pediatric neurology patient is particularly challenging, comments, “I didn’t expect to be able to wake up the child and extubate him right away. But the Hadassah team—nurse, surgeons, and anesthesiologists— was great. Communication among us was perfect, as always with Dr. Elor, and that is why the outcome was even better than one might expect.”

Multiple factors determine the extent of damage a gunshot wound causes. These include the caliber of the gun, the size and the speed of the bullet, the trajectory, and the site of the injury, and the surgical team’s skill.

“It’s quite remarkable,” says Dr. Elor, “that two days after the surgery, the boy is eating, talking, and moving his limbs.”

Main picture captions: An x-ray image of a bullet lodged in the brain of a 9-year-old boy at Hadassah University Hospital in Jerusalem on July 31, 2020