Conservative non-surgical management of penetrating cardiac injury with three retained metal nails: a case report

Traumatic penetrating cardiac injuries are usually immediately fatal. The management approach (surgical vs. conservative) in surviving patients can be challenging. A conservative approach is appropriate in selective cases; however, long-term complications should be considered. A frail 83-year-old male who had undergone coronary artery bypass grafting surgery 20 years ago presented with encephalopathy. He had persistent bacteraemia. Chest computed tomography revealed three metal nails penetrating the anterior thoracic wall through the myocardium. Later, we learned that he had attempted suicide 2 years ago by shooting himself in the chest using a nail gun. Conservative non-surgical approach was pursued at that time given his multiple comorbidities. We adopted a conservative approach again. He survived for additional 6 months on chronic suppressive antimicrobial therapy but ultimately passed away from pneumonia. The favourable outcome in this patient underscores the role of a conservative approach in selective cases. Retained foreign bodies pose a risk of infective endocarditis; therefore, empirical chronic antimicrobial therapy and tetanus vaccination should be considered.