Delayed inferior vena cava-to-right ventricle bullet embolism following abdominal gunshot injury in somalia: a case report

Bullet embolism is an uncommon consequence of gunshot wounds, with venous migration to the right heart reported sporadically in the literature. Diagnostic delays are frequent in low-resource settings, where advanced imaging and endovascular retrieval are limited. A 26-year-old Somali man sustained an abdominal gunshot injury managed by emergency laparotomy; the projectile was not retrieved. Postoperative paraplegia required lumbar spinal fixation. Eight weeks later after the initial injury, serial radiography demonstrated cranial migration of the retained bullet from the infrarenal inferior vena cava to the right ventricle (RV). Open retrieval under cardiopulmonary bypass through median sternotomy was performed, and the patient was discharged without any cardiac complications. This case highlights the need for vigilant follow-up imaging when a bullet’s resting site does not correspond with its entry trajectory, especially in resource-constrained environments. Prioritizing targeted follow-up imaging and expanding minimally invasive retrieval capabilities could reduce the morbidity associated with delayed intracardiac missile migration.