Jaha Luan, Ademi Bekim, Ismaili-Jaha Vlora, Andreevska Tatjana
Department of Vascular Surgery, University Clinical Center of Kosova, Rrethi i Spitalit pn, 10000 Prishtina, Republic of Kosova.
J Med Case Rep. 2011 Aug 5;5:354. doi: 10.1186/1752-1947-5-354.
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.
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.
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.
腹部血管创伤在现代平民生活中相当常见，是一种致死率很高的损伤。然而，如果射弹足够小，如果其在穿过组织时能量减弱，并且如果动脉系统足够有弹性，动脉的入口伤口可能会闭合而不发生出血，因此可能不会致命。捕获的射弹甚至可能向下游移动，直到被较小的远端血管系统阻挡。这种现象的发生很罕见，最早由特林布尔于1968年描述。
我们在此报告一例29岁的阿尔巴尼亚男子，因背部枪伤，导致第十二胸椎和第一腰椎骨折，腹主动脉后壁损伤，随后子弹栓塞至左髂外动脉。有趣的是，远端缺血的体征在探查手术后数小时出现，这增加了子弹在此期间迁移或在探查手术期间未被识别的可能性。
在所有腹部或胸部有枪伤且无出口伤口且该区域无射弹的病例中，应高度怀疑可能存在子弹栓塞，特别是在存在远端缺血的情况下。
