Work

Conservative management of bullet lodged in the interventricular septum of the heart: a case report

Year: 2025

Type: article

Abstract: BACKGROUND: Penetrating cardiac injuries from gunshot wounds are rare but potentially fatal. When a bullet is retained within the heart, surgical removal is usually recommended owing to risks of tamponade, arrhythmia, embolization, or infection. However, conservative management may be an option in select hemodynamically stable patients. We present a unique case to highlight this approach. CASE PRESENTATION: A 37-year-old South Asian male sustained a gunshot wound to the right hemithorax, resulting in a bullet lodged in the interventricular septum. Diagnostic imaging confirmed the bullet's stable position with no pericardial effusion or significant cardiac dysfunction. He was managed conservatively with an intercostal chest drain for associated hemothorax, broad-spectrum antibiotics, and close monitoring. A multidisciplinary team including trauma surgeons, cardiologists, and cardiothoracic surgeons determined that nonoperative management was feasible. The patient remained asymptomatic during hospitalization and follow-ups for 1 year, with no evidence of bullet migration, embolism, or infection. CONCLUSION: This case report demonstrates that, in carefully selected, hemodynamically stable patients with retained intracardiac bullets, conservative management may be a safe and effective alternative to surgical removal. It underscores the importance of individualized decision-making and close multidisciplinary follow-up.

Source: Journal of Medical Case Reports

DOI: 10.1186/s13256-025-05716-y

Authors: Pankaj Aggarwal, Sanketh Edem, Sachin Mahajan, Uday Tej, Jigyasa Bharti

Institution: Post Graduate Institute of Medical Education and Research

Language: English

Topic: Trauma Management and Diagnosis

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,890