A case report of a retained interventricular septal bullet after gunshot wound

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.