Multiple sites bullet embolism as a cause of acute abdomen

Area of Science:

• Traumatology
• Vascular Surgery
• Radiology

Background:

• Bullet embolism (BE) is a rare and often misdiagnosed consequence of penetrating trauma.
• It involves bullet migration through vascular structures, potentially causing severe ischemia.

Observation:

• A 25-year-old male presented with penetrating trauma from a firearm projectile.
• The patient exhibited two distinct bullet embolism destinations: the right brachial artery and superior mesenteric artery branches.
• This resulted in acute ischemic repercussions in both the upper limb and the abdominal vasculature.

Findings:

• Surgical exploration was performed to assess ischemia and remove the foreign body.
• This case represents the first reported instance of acute vascular abdomen secondary to bullet embolism.
• The patient experienced critical ischemia in both the brachial artery and mesenteric arteries.

Implications:

• There is no established standard treatment for bullet embolism; management must be individualized.
• Early diagnosis via imaging is crucial for recognizing this rare but critical condition.
• Medical teams should consider multiple and unusual presentations of critical ischemia in cases of suspected bullet trajectory suggesting embolism.