Ballistic trauma in great apes is exceptionally uncommon and rarely described in the medical or veterinary literature [1,2]. This report describes the management of a Western Lowland gorilla with gunshot injuries using established human civilian trauma principles at a South African Level 1 Trauma Center. The case highlights the translation of modern penetrating trauma management strategies, including selective non‑operative management (NOM), radiological trajectory analysis, and avoidance of unnecessary retained projectile extraction, into zoological medicine. The case also might raise some theoretical thoughts on modern treatment possibilities. This case report was prepared in accordance with the CARE reporting guidelines.

On 18 July 1997, a violent incident occurred at Johannesburg Zoo when an armed intruder entered the gorilla enclosure while attempting to evade police. During the confrontation, a 26‑year‑old male Western Lowland gorilla named Max sustained two gunshot wounds involving the neck and upper torso region. Following initial stabilization by the Johannesburg Zoo veterinary team, the animal was sedated, intubated, and transferred to Milpark Hospital, then the only Level 1 Trauma Center in South Africa, for further trauma assessment and radiological evaluation See Figure 1. The primary concern on arrival was to determine whether the injuries represented deep penetrating ballistic trauma or tangential wounds without major cavitary violation.

This case demonstrates the successful application of human civilian trauma principles to the management of ballistic injury in a great ape. The central educational value lies not in the rarity of the species involved, but in the translation of evidence‑based trauma concepts across species boundaries [1,3–7].

The team decided on NOM because operative ex‑traction would have required extensive dissection through deep muscular structures with increased tissue trauma and prolonged anesthetic exposure. Con‑temporary trauma principles recognize that retained bullets are frequently biologically inert and that removal might produce greater morbidity than retention unless specific indications are present [4]. Avoidance of unnecessary surgery was particularly important given the anesthetic, physiological, and logistical challenges associated with management of a large non‑human primate.

Selective NOM has become a cornerstone of modern penetrating trauma care in high‑volume trauma systems [4–6]. The decision‑making process in this case closely paralleled contemporary human ballistic trauma algorithms emphasizing physiological stability, careful imaging assessment, and avoidance of unnecessary exploration. The use of external bullet markers during imaging represented an important practical adjunct in determining wound trajectory and excluding major cavitary penetration. Although commonly used in trauma radiology, this technique is infrequently described in zoological trauma management [2,8]. One might add that computed tomography (CT) could have been used to identify the injuries pattern but body size and weight might have limited the possibilities to perform CT in this case.

The case also highlights the importance of multidisciplinary collaboration between veterinary and trauma surgery teams. Airway management, sedation, transport logistics, physiological monitoring, imaging, and clinical decision‑making required coordinated interaction between multiple disciplines. Retained projectile management remains an important issue in both human and veterinary trauma care. Modern literature generally supports selective retained bullet removal only when clear indications exist, including infection, intra‑articular location, migration risk, vascular compromise, or persistent symptoms attributable to the projectile [1,3,7].

In general, one might hypothesize that use of endovascular or hybrid tools to stop ongoing large vessels bleeding could be helpful. Exposure of axillar, subclavian, or other major vessels in a very muscular ape would have been challenging, and wide exposure would probably have been harmful. At least in theory, the use of balloon occlusion, endograft, and embolization could have been helpful [9].

This case report illustrates the successful management of ballistic trauma in a Western Lowland gorilla using modern civilian trauma principles and selective non‑operative management strategies. The case further demonstrates the value of multidisciplinary cooperation between veterinary and human trauma systems and represents an unusual but important example of cross‑species application of evidence‑based trauma care.