Year 2020 Vol. 28 No 4

CASE REPORTS

V.A. PODKAMENNIY 1, 2, A.A. SHARAVIN 1, Y.V. ZHELTOVSKY 1, 2, 3, A.V. VYRUPAEV 1, S.V. IMSYROV 1

SHOTGUN PELLET EMBOLISM TO THE GREAT SAPHENOUS VIEN

Irkutsk Regional Clinical Hospital 1,
Irkutsk Medical Academy of Post-graduate Education 2,
Irkutsk State Medical University 3, Irkutsk,
The Russian Federation

A gunshot wound is the main type of injury during combat operations. In peacetime, it is relatively rare and can be the result of criminal incidents or hunting accidents. In this clinical case, the pellet embolism due to the sacrum gunshot wound is described. The pellet from the inferior Vena cava or iliac vein retrograde under its own weight descended into the femoral and then into the large saphenous vein of the thigh, where it stopped thanks to the valves. For 21 years after the injury and embolism of the great saphenous vein of the thigh, the patient made no complaints. The presence of pellet in the vein was a godsend for mammarocoronary bypass surgery for the coronary heart disease. A fragment of the large saphenous vein of the femur on the right thigh was isolated endoscopically. When processing the vein, two pellets with obliteration of the lumen were found. Publications on intravascular embolism by pellet or bullet after gunshot trauma are rare. Embolisms can be observed in both the arterial and venous systems. According to the authors, venous embolisms are less common than arterial ones. Due to the small number of publications, this clinical case is of interest.

Keywords: shotgun wound, venous bullet embolism, pellet, coronary heart disease, coronary bypass surgery
p. 456-459 of the original issue
References
  1. Greaves N. Gunshot bullet embolus with pellet migration from the left brachiocephalic vein to the right ventricle: a case report. Scand J Trauma Resusc Emerg Med. 2010 Jun 20;18:36. doi: 10.1186/1757-7241-18-36
  2. Huebner S, Ali S. Bilateral shotgun pellet pulmonary emboli. J Radiol Case Rep. 2012 Apr;6(4):1-10. doi: 10.3941/jrcr.v6i4.940
  3. Bakan S, Korkmazer B, Baş A, Şimşek O, Barman HA, Çebi Olgun D. Embolism of a pellet after shotgun injury: From liver to right ventricle. Ulus Travma Acil Cerrahi Derg. 2016 Jul;22(4):395-98. doi: 10.5505/tjtes.2015.32470
  4. Vedelago J, Dick E, Thomas R, Jones B, Kirmi O, Becker J, Alavi A, Gedroyc W. Look away: arterial and venous intravascular embolisation following shotgun injury. J Trauma Manag Outcomes. 2014 Nov 15;8:19. doi: 10.1186/1752-2897-8-19. eCollection 2014.
  5. Dada MA, Loftus IA, Rutherfoord GS. Shotgun pellet embolism to the brain. Am J Forensic Med Pathol. 1993 Mar;14(1):58-60. doi: 10.1097/00000433-199303000-00014
  6. Fisk RL, Addetia A, Gelfand ET, Brooks CH, Dvorkin J. Missile migration from lung to heart with delayed systemic embolization. Chest. 1977 Oct;72(4):534-35. doi: 10.1378/chest.72.4.534
  7. Hussein N, Rigby J, Abid Q. Bullet embolus to the right ventricle following shotgun wound to the leg. BMJ Case Rep. 2012 Dec 14;2012. pii: bcr2012007471. doi: 10.1136/bcr-2012-007471
  8. Schurr M, McCord S, Croce M. Paradoxical bullet embolism: case report and literature review. J Trauma. 1996 Jun;40(6):1034-36. doi: 10.1097/00005373-199606000-00034
  9. Decker HR. Foreign bodies in the heart and pericardium: should they be removed? J Thorac Surg. 1939 Oct;9(1):62-79. doi: 10.1016/S0096-5588(20)32043-2
Address for correspondence:
664049, Russian Federation,
Irkutsk, mcr. Yubileynyiy, 100,
Irkutsk Regional Clinical Hospital,
the Cardiac Surgery Unit No1,
tel. mobile: +7 950 125-63-90,
e-mail: trew1986@list.ru,
Sharavin Anatoliy A.l
Information about the authors:
Podkamenniy Vladimir A., MD, Professor of the Department of Cardiovascular Surgery, Cardiovascular Surgeon, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-3465-792X
Sharavin Anatoliy A., Cardiovascular Surgeon, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/ 0000-0003-1073-1213
Zheltovskyi Yurii V., MD, Professor of the Department of Cardiovascular Surgery, Cardiovascular Surgeon, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-3269-0195
Vyrupaev Alexei V., Cardiologist, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0001-6474-2917
Imsyrov Sergei V., Anesthesiologist, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0003-4465-4199
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