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

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.