Venous bullet embolism and subsequent endovascular retrieval - A case report and review of the literature.

INTRODUCTION: Vascular bullet embolism is a rare phenomenon with fewer than 200 cases reported in the literature. PRESENTATION OF CASE: A 22 year-old male presented with a gunshot wound to the right lower quadrant. Imaging demonstrated a bullet lodged in his left lower quadrant. Upon operative exploration, a single hole was found in the right external iliac vein without injury into the left lower quadrant. The bullet was found to have migrated intravascularly from the right external to the left common iliac vein, and was subsequently removed endovascularly. DISCUSSION: Bullet embolism occurs infrequently, with arterial more common than venous. Arterial embolization usually requires emergency operative intervention due to ischemia. While venous embolization is often asymptomatic, removal of the bullet is recommended to avoid delayed complications when possible.
CONCLUSION: Venous bullet emboli should be removed endovascularly whenever technically possible.