title: Bullet embolization to the external iliac artery after gunshot injury to the abdominal aorta: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Vascular Surgery, University Clinical Center of Kosova, Rrethi i Spitalit pn, 10000 Prishtina, Republic of Kosova. ljaha@yahoo.com.
authors.forename: Luan
authors.initials: L
authors.lastname: Jaha
authors.forename: Bekim
authors.initials: B
authors.lastname: Ademi
authors.forename: Vlora
authors.initials: V
authors.lastname: Ismaili-Jaha
authors.forename: Tatjana
authors.initials: T
authors.lastname: Andreevska