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Bullet embolism is a rare and unpredictable complication of gunshot and mine‑explosive injuries. With only few cases described in the literature, bullet embolism may become a diagnostic challenge for emergency and military surgeons. Thus, bullet embolization is a rare phenomenon, the complications can be devastating.A clinical case of bullet embolism is described. 34‑years old man got combined abdominal‑skeletal mine‑explosive injuries with damage to hollow organs (duodenum and transverse colon), inferior vena cava and both low extremities. Internal bleeding was stopped by the inferior vena cava edge wound suturing. Wounds of duodenum and large intestine were sutured; gunshot fractures of both tibial bones were stabilized with external fixation devices. Computer tomography of the entire body showed the presence of embolus in the right middle lobe artery. Clinical manifestations of pulmonary embolism were not observed. The patients had several complications after surgery such as: multiple focal necrosis and perforations of transverse colon caused a fecal peritonitis; duodenum suture failure caused forming of a duodenal fistula; postoperative wound infection. These complications necessitated performing of multiple reoperations. Attempts of endovascular bullet extraction didn’t undertake because of severe concomitant injuries, its complications and asymptomatic clinical course of pulmonary artery projectile embolism. Open surgery removing of embolus was successfully performed in 80 days after injury. The patient was discharged from hospital in good condition in 168 days after gunshot wound. Patients with an explosive‑mine wound and gunshot wound with no exit should to be examined with whole‑body computer tomography for determining possible projectile migration with bloodstream. Patients with asymptomatic pulmonary artery embolism should to be managed non‑operatively in the early posttraumatic period. In case of symptomatic pulmonary artery bullet embolism is reasonable to consider of a possibility of an open thoracic surgery.

The aim — to analyze the experience of surgical treatment of patients with posttraumatic arteriovenous discharges in the lower limbs. During the period of the Anti-Terrorist Operation in the east of Ukraine, 8 patients with AV-discharge aged 25 to 57 years old (middle age — 42 years) were hospitalized in the department of vascular surgery at the National Military Medical Clinical Center «Main Military Clinical Hospital». In all patients, AV-fistulas arose as a result of fragmentation wounds of the vessels of the extremities. All patients underwent primary surgical debridement of wounds and repositioning of bone fragments. By localization the distribution of damage was as follows: the predominant affection of vessels of middle caliber — 10 (56 %), arteries of lower extremities — 10 (56 %), including femoral arteries — 5 (50 %), popliteal arteries — 3 (30 %), the anterior tibia arteries — 1 (10 %), posterior tibia arteries — 1 (10 %). Open surgery was performed in 6 (75 %) cases, X-ray-endovascular — in 1 (12.5 %), combined stage-by-stage treatment — in 1 (12.5 %). Minimally invasive endovascular interventions are effective both in acute and chronic vascular trauma, but the possibility of their use is limited by anatomical features. Radical surgical elimination of the AV-discharge guarantees an improvement in the systemic hemodynamics indicators already in the early postoperative period. Methods of X-ray endovascular occlusion and endovascular prosthetics, as well as the combined use of surgical and X-ray endovascular methods, can be independent methods of treating traumatic injury.