Accidentally Ingested sewing pin pierces heart- case report

This rare complication has been recently reported by Dr. Bonnie Mathews and team attached to the Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Massachusetts Medical School.

Intracardiac foreign bodies have been described in the literature, however, they are rare entities, particularly in pediatric patients. Most of the reported cases of intra-cardiac needles have been shown to cause cardiac tamponade, have dysfunction, recurrent arterial embolism, or chronic constrictive pericarditis, while a few cases remained asymptomatic owing to completely embedded needle in the myocardium.

The treatment of the intra-cardiac foreign body is controversial owing to limited numbers of cases.Establishing the exact position of the foreign body is essential.

Previously some suggested that asymptomatic old foreign bodies in the heart may be well managed conservatively, as removing old foreign bodies attached to myocardium may lead to serious complications. They implied that the timing of diagnosis since the injury is important for a decision to intervene.contrary to this, others thought that early removal of foreign bodies was recommended because they eventually could migrate.

The 17-year-old boy presented to the Emergency Department with 3 days of chest pain. The teen complained the pain was sharp, radiated to his back, and was worse when lying down or breathing deeply. In the absence of prodromal symptoms or a history of trauma, it was suggestive of perimyocarditis. It refers to inflammation of the heart muscle and the surrounding membrane.

Lab tests also showed the teen had increased levels of proteins in his blood, indicating the chances of a heart injury.

Electrocardiogram at the time of presentation demonstrated diffuse ST-segment elevation, again consistent with perimyocarditis.

A chest radiograph revealed a linear density in the anterior mid-chest, concerning for foreign body. Chest computed tomography confirmed the presence of a 3.5-cm linear metallic foreign body within the right ventricle.

It was only at a second investigation that the boy confirmed that he tailors his clothes and sometimes holds sewing pins in his mouth, though he said he wasn't aware of ingesting a sewing pin.

Following diagnosis, he underwent open-heart surgery to remove the object, which doctors found was indeed a sewing pin. Fortunately, the teen recovered after his surgery and "has had no complications to my knowledge," Mathews said.

The new case "highlights the potentially devastating complications of foreign body ingestion," the authors wrote in the report.

"Serious consideration should be given to the … removal of all ingested sharp, linear, gastric foreign bodies to prevent complications due to migration such as the one described in this case," they concluded.

For the full article, click on the link: https://doi.org/10.1016/j.jemermed.2020.06.036

Primary source: The Journal of Emergency Medicine