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This case report presents an alternative approach in a carefully selected, hemodynamically stable patient. A 37-year-old man with a bullet lodged in the interventricular septum was treated nonoperatively with supportive drainage, antibiotics, and close multidisciplinary monitoring.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/conservative-management-of-bullet-lodged-in-the-interventricular-septum-of-the-heart-a-case-report/422900/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/conservative-management-of-bullet-lodged-in-the-interventricular-septum-of-the-heart-a-case-report/422900.png","ImageObject",300,407,{"name":92,"@type":93},"CatatanPagi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is surgical removal usually recommended for bullets retained in the heart?","Question",{"text":113,"@type":114},"Surgical removal is generally advised to reduce risks such as cardiac tamponade, arrhythmias, embolization, and infection.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What diagnostic findings supported conservative management in this case?",{"text":118,"@type":114},"Imaging confirmed the bullet’s stable position in the interventricular septum without pericardial effusion or significant cardiac dysfunction.",{"name":120,"@type":111,"acceptedAnswer":121},"How was the patient managed conservatively, and what were the outcomes?",{"text":122,"@type":114},"The patient received an intercostal chest drain for hemothorax, broad-spectrum antibiotics, and close monitoring. He remained asymptomatic during hospitalization and follow-ups for one year, with no migration, embolism, or infection.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},422900,1790792935,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52,"preview_page_count":4},962090894170,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Aggarwal etal.  \nJournal of Medical Case Reports (2026) 20:6 [https://doi.org/10.1186/s13256-025-05716-y](https://doi.org/10.1186/s13256-025-05716-y)  \nJournal of Medical Case Reports  \n CASE REPORT Open Access  \nConservative management of bullet lodgedin the interventricular septum of the heart: a case report  \nPankaj Aggarwal1, Sanketh Edem 1* , Sachin Mahajan1, Uday Tej1 and Jigyasa Bharti 1  \nAbstract  \nBackground 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.  \nCase 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.  \nConclusion 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.  \nKeywords Gunshot wounds, Cardiac trauma, Interventricular septum, Conservative management, Retained cardiac bullet  \nIntroduction  \nPenetrating thoracic injuries remain a significant source of morbidity and mortality, with gunshot wounds (GSWs) posing a particularly grave threat owing to their potential to injure vital intrathoracic structures. Among these, cardiac involvement is especially critical and often fatal, owing to the heart’s central anatomical location and the potential for rapid hemodynamic collapse. Although  \n*Correspondence:  \nSanketh Edem [sanketh.edem@gmail.com](sanketh.edem@gmail.com)  \n1 Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India  \nmost cardiac GSWs necessitate urgent surgical intervention, the management strategy becomes less straightforward when a patient is hemodynamically stable and the projectile is retained within the heart without causing acute complications [1].  \nIntracardiac foreign bodies such as bullets may lead toa variety of adverse outcomes including cardiac tamponade, arrhythmias, infection, embolism, and myocardial perforation. Accordingly, surgical removal is traditionally advised to prevent delayed complications. However, in select cases, particularly when the foreign body is stable and not impinging on critical cardiac structures, conservative (nonsurgical) management may be feasible [2].  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitt","cbCaihHEYFfgufuA","https://ap.wps.com/l/cbCaihHEYFfgufuA","pdf",780449,"English","# Abstract\n# Background\n# Case presentation\n## Initial presentation and diagnostics\n## Conservative treatment and follow-up\n# Conclusion","[{\"question\":\"Why is surgical removal usually recommended for bullets retained in the heart?\",\"answer\":\"Surgical removal is generally advised to reduce risks such as cardiac tamponade, arrhythmias, embolization, and infection.\"},{\"question\":\"What diagnostic findings supported conservative management in this case?\",\"answer\":\"Imaging confirmed the bullet’s stable position in the interventricular septum without pericardial effusion or significant cardiac dysfunction.\"},{\"question\":\"How was the patient managed conservatively, and what were the outcomes?\",\"answer\":\"The patient received an intercostal chest drain for hemothorax, broad-spectrum antibiotics, and close monitoring. He remained asymptomatic during hospitalization and follow-ups for one year, with no migration, embolism, or infection.\"}]","Conservative management of bullet lodged in the interventricular septum of the heart - a case report | PDF",1790629237]