Abstract
IntroductionAbdominal 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 presentationHere 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.ConclusionIn 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.
Highlights
Abdominal vascular trauma is fairly common in modern civilian life and is a highly lethal injury
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 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
Summary
Abdominal vascular trauma is fairly common in modern civilian life and is a highly lethal injury, with overall mortality around 40% in some reported series. We present our experience with a gunshot injury through the lumbar vertebra to the posterior wall of the abdominal aorta, followed by bullet embolism to the left external iliac artery. With no pulse up to the common femoral artery and there were signs of discoloration Computed tomography of his chest and abdomen revealed two bullets - one in his left iliac fossa and a second in front of his sacrum (Figure 1). There was a multiple fracture of his twelfth thoracic and first lumbar vertebrae with no free fluids in his abdomen (Figure 2) These findings alerted the vascular surgery team and after a consultation, a tentative diagnosis of a gunshot injury was made. The leg performed well after the surgery, the postoperative period was complicated by multiorgan failure, which resulted in the death of our patient eighth days after receiving the injury
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