Intracardiac shrapnel fragment after blast injury in a hemodynamically stable patient: a case report from Somalia

In conflict-affected regions such as Somalia, injuries resulting from terror-related explosions impose a substantial public health burden. Shrapnel injuries are frequently encountered and often lead to multiple trauma, with penetrating thoracic injuries among the most clinically significant. Although rare, cardiac trauma presents considerable diagnostic and therapeutic challenges for emergency physicians and trauma surgeons. While surgical intervention is typically indicated in hemodynamically unstable patients, the optimal management for retained intracardiac foreign bodies (FBs) in stable patients remains an area of clinical uncertainty. The decision between surgical removal and conservative observation is influenced by several factors, including hemodynamic stability, the presence of cardiac complications, and the characteristics of the retained object. We present a case of a hemodynamically stable patient in Somalia with a retained intracardiac shrapnel fragment following a terror-related explosion. Imaging studies, particularly transthoracic echocardiography, revealed a foreign body within the pericardial space, without evidence of tamponade or myocardial injury. Given the stable clinical course and absence of acute cardiac pathology, a non-operative strategy with close clinical and echocardiographic monitoring was adopted. The patient remained complication-free and was successfully managed. This case underscores the feasibility of conservative treatment in selected hemodynamically stable patients with intracardiac FBs and highlights the necessity of an individualized, multidisciplinary clinical approach in complex trauma scenarios.