Abdominal shotgun wound with pellet embolization leading to bilateral lower limb amputation : case report and review of the literature of missile emboli over the past 10 years

Missile embolus is an unusual but recognized complication of gunshot injuries. Originally described in 1834, some 160 cases were reported in 1996. We present a case study of a 17-year-old man with an abdominal shotgun wound who, in addition to serious internal injuries, also sustained pellet embolization of the lower limb arterial supply resulting in bilateral below-knee amputations. A PubMed search (www.ncbi.nlm.nih.gov./ PubMed, 1995 to September 2006) was performed using a combination of the MeSH term foreign body vascular embolism with additional text words (pellet embolism, bullet embolism, missile embolism, and embolectomy). Reference lists of the retrieved literature were manually cross-searched for additional publications. This yielded 45 reported cases. Data from these cases were correlated and compared. Categories analyzed included the patient’s age, morbidity and mortality, type of firearm used, the distance of the shooter, the source and destination of the embolus, whether the embolus was venous or arterial, and whether it was anterograde or retrograde. Presenting symptoms were correlated with the arterial or venous nature of the embolus. The nature of interventions was reviewed. Data were tabulated, and simple statistical methods were used for analysis using standard computer software. Based on the presented case and the literature review, recommendations for the diagnosis and management of a missile embolus are made.