Right hepatic vein bullet embolism: A case report

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Radiology

Background:

• Gunshot wounds (GSW) require thorough assessment to identify all injuries and projectile trajectories.
• Missile embolism (ME), a rare complication, involves a projectile embolizing through vasculature, potentially causing severe systemic damage.
• ME can occur in arterial or venous systems, leading to diverse and life-threatening conditions like stroke or limb ischemia.

Observation:

• This case report details an 18-year-old male with a GSW and inferior vena cava laceration.
• A bullet was found to have embolized to the right hepatic vein, a venous ME.
• The patient underwent exploratory laparotomy to identify the injury and projectile location.

Findings:

• The bullet's final location in the right hepatic vein was confirmed.
• Treatment for ME depends critically on the projectile's location within the circulatory system.
• Venous ME may be managed conservatively if the patient is asymptomatic.

Implications:

• Accurate diagnosis and localization of embolized projectiles are crucial for effective management.
• Arterial ME typically requires retrieval, whereas venous ME offers conservative options.
• Understanding ME pathophysiology guides treatment strategies, balancing risks and benefits for patient outcomes.