Key result
Non-operative management including serial echocardiography and empiric colchicine was utilized for a 25-year-old male surviving with two bullet fragments in the interventricular septum.
Why the study?
Retained myocardial bullets are exceedingly rare clinical events with scant literature available to guide clinical decisions regarding non-operative management versus surgical extraction.
Case Report (n=1)
Non-operative management with serial echocardiography and prophylactic colchicine may be a viable strategy for stable patients with retained myocardial bullets.
Answers are grounded in this paper and cite their sources.
Rare survival after septal gunshot injury with surveillance and colchicine; leaves open optimal management for cardiac penetrating trauma.
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.
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Smith et al. (2021) conducted a case report in Retained interventricular septal bullet fragments after gunshot wound (n=1). Non-operative management (serial echocardiographic surveillance and empiric colchicine) was evaluated. Non-operative management including serial echocardiography and empiric colchicine was utilized for a 25-year-old male surviving with two bullet fragments in the interventricular septum.
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