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A case report of a retained interventricular septal bullet after gunshot wound
Brandon M Smith1, Elisabeth Loomis1, Logan Erz1
1Department of Trauma, Akron City Hospital, Akron, OH, USA.
Insights
Surviving cardiac gunshot wounds is rare. This case highlights successful non-operative management of retained interventricular septal bullet fragments, warranting consideration for pericarditis prophylaxis and echocardiographic surveillance.
Area of Science:
- Cardiology
- Trauma Surgery
- Forensic Pathology
Background:
- Cardiac gunshot injuries typically have a poor prognosis.
- Retained myocardial bullet fragments present rare and complex clinical scenarios.
Observation:
- A 25-year-old male survived multiple gunshot wounds.
- Two bullet fragments were found lodged in the interventricular septum.
Findings:
- Non-operative management with serial echocardiography was employed.
- A two-month course of colchicine was administered for pericarditis prophylaxis.
Implications:
- Non-operative management is a viable option for stable patients with retained cardiac bullet fragments.
- Colchicine prophylaxis and echocardiographic surveillance are important considerations.
- Risk-benefit analysis is crucial for managing retained myocardial bullets.
Abstract:
Cardiac gunshot injuries herald a universally grim prognosis. We present an exceedingly unique case of a patient surviving multiple gunshot wounds with two bullet fragments lodged in the interventricular septum. A 25-year-old male sustained four gunshot wound injuries to the upper body. Two cardiac interventricular septal bullet fragments were identified during his recovery. Management included serial echocardiographic surveillance and a two-month regimen of empiric colchicine for prophylaxis against post-traumatic pericarditis. Pursuing non-operative management especially in asymptomatic or stable patients should be evaluated against surgical extraction and possible sequelae of complications. The consideration of scheduled colchicine for pericarditis prophylaxis is warranted as well as interval echocardiogram. Retained myocardial bullets are exceedingly rare clinical events with scant literature available to guide clinical decisions. Management requires intricate decision-making and close consideration of risk benefit analysis weighing surgical extraction against non-operative management.