ABSTRACT
INTRODUCTION:
Abdominal vascular
trauma is fairly common in modern civilian
life and is a highly lethal
injury. However, if the projectile is small enough, if its energy is diminished when passing through the
tissue and if the arterial system is elastic enough, the entry
wound into the
artery may close without
exsanguination and therefore may not be fatal. A projectile captured may even
travel downstream until it is arrested by the smaller distal vasculature. The occurrence of this phenomenon is rare and was first described by Trimble in 1968. CASE PRESENTATION Here we present a case of a 29-year-old Albanian man
who, due to a gunshot
injury to the
back, suffered fracture of his twelfth thoracic and first lumbar
vertebra,
injury to the posterior wall of his
abdominal aorta and then bullet
embolism to his left external
iliac artery. It is interesting that the signs of distal
ischemia developed several hours after the exploratory
surgery, raising the possibility that the bullet migrated in the interim or that there was a failure to recognize it during the exploratory
surgery.
CONCLUSION:
In all cases where there is a gunshot
injury to the
abdomen or
chest without an exit
wound and with no projectile in the area, there should be a high index of suspicion for possible bullet
embolism, particularly in the presence of the distal
ischemia.
