Multiple sites bullet embolism as a cause of acute abdomen

Bárbara Lôbo de Figueirêdo1, Priscylla Jennie Monteiro Rabêlo2, Adercio Pereira da Silva1, Luiz Eduardo Rafael Moutinho3, Olival Cirilo Lucena da Fonseca Neto2

1Department of Vascular Surgery, Hospital da Restauração Governador Paulo Guerra, Recife, Brazil
2Department of Trauma Surgery, Hospital da Restauração Governador Paulo Guerra, Recife, Brazil
3School of Medicine, Universidade de Pernambuco, Recife, Brazil

Keywords: Bullet embolism, case report, gunshot wounds, vascular trauma

Abstract

Bullet embolism (BE) is a rare and misdiagnosed phenomenon that can significantly affect the cardiovascular system. It occurs when a bullet enters and migrates through the body vessels in gunshot victims. We report in this article a case of a 25-year-old male patient, victim of penetrating trauma caused by a firearm projectile that presented two embolism destinations with acute ischemic repercussions: the right brachial artery and the branches of the superior mesenteric artery. We quickly performed surgical exploration to assess the level of ischemia and resect the foreign body. To the best of the authors' knowledge, this is the only case of acute vascular abdomen due to BE in the literature. There is no standard treatment for BE, and each case should be studied according to signs and symptoms while considering the risks of the destination vessel for the victim. Imaging is necessary for early diagnosis, and the medical team must be aware of multiple and extraordinary critical ischemia presentations when bullet trajectory suggests embolism.

Ethics Committee Approval

The case report protocol was approved by Institution Reviewer and Ethical Board in human research (CEP/HR) numbered CAAE 37281620.9.0000.5198 on October 6, 2020. The patient consent has been obtained.

Author Contributions

BF: Clinical management (equal), data curation (lead), investigation (equal), writing – original draft (supporting), visualization (equal). PR and AS: Clinical management (equal), data curation (supporting), investigation (equal). LM: Literature review, writing – original draft (lead), writing – review and editing (supporting), visualization (equal), (lead). ON: Clinical management (supporting), project administration (lead), supervision (lead), writing – review and editing (lead).

Conflict of Interest

None Declared.

Financial Disclosure

None.