Intracardiac needle in a man with self-injurious behaviour presenting with only a heart murmur

Unsuccessful suicidal attempts by sewing needle introducing to chest: Removing 17 ones from the right ventricle and breast tissue in two stages; case report and literature review

INTRODUCTION AND IMPORTANCE

Penetrating cardiac injuries among the whole injuries confronting the trauma surgeon is more alarming. The introduction of needles as an attempt to inflict self-injury has rarely been described, so we only found 34 reported cases reviewing the available English literature since 1967.

CASE PRESENTATION

We have reported a case of a 35-year-old depressed female who had introduced 17 sewing needles through her chest wall, causing myocardial puncture and mastitis; underwent exploratory sternotomy and mammoplasty in two stages and survived.

CLINICAL DISCUSSION

Penetrating cardiac trauma is rare enough for surgeons to deal with direct injuries by sewing needles. Penetrating wounds in the "cardiac box" anatomic area" should elicit the highest concern for potential cardiac injury. The mentioned region is demarcated superiorly by the clavicles, inferiorly by the xiphoid, and the nipples laterally in an area of the anterior thorax.

CONCLUSION

Anterior aspect penetrating traumas to the cardiac box myocardial injuries should be in mind, and immediate and proper intervention should be needed. Ventricles, for their anatomical condition, are exposed to be injured.

Self-Embedding Behavior in Adults: A Report of Two Cases and a Systematic Review

Self-embedding behavior (SEB) is the repeated insertion of sharp objects, such as needles or pins, into the soft tissues of abdomen, limbs, and other body parts. In this study, two cases of SEB were reported and the scientific worldwide literature reviewed. Thirty-two cases of SEB were identified through systematic searches in the main bibliographic databases. Mean age was 35 years (SD = 8.97). Just over two-thirds of the patients were female. Although the number of embedded objects could be as high as 200, major clinical and surgical complications were uncommon and mortality was null. Patients with SEB presented three major diagnoses: psychotic (25%), personality (21.9%), and factitious (28.1%) disorders. The practice of SEB largely went undetected as the patients themselves did not bring it to the attention of family members or physicians and usually denied they have engaged in SEB. A high level of suspicion is required to avoid a missed diagnosis.

Multiple self-inserted pins and nails in pericardium in a patient of schizophrenia: Case report and review

This report is the case of multiple self-inserted pins and nails in chest and pericardial cavity in a young male suffering from schizophrenia. This act of self-mutilation was done to get relief from burning sensation in chest and palpitations. Review of the relevant literature revealed that self-inflicted intra-cardiac needle injuries occur mainly in young and middle-aged adults suffering from psychiatric disorders, commonly depression, schizophrenia, and substance use disorders. In one-fourth of the patients, it is due to deliberate self-harm. About 70% use a single needle but 30% may use multiple needles. Second attempts are rare. Majority of the patients (85%) are managed by surgery and recover from the injury. The condition has a low mortality rate of 5%.

Cardiac tamponade caused by migration of a swallowed sewing needle

The case of a 20-year-old female prisoner who died due to cardiac tamponade caused by a swallowed sewing needle migration is reported. According to the autopsy report and complete analysis of medical records, the migration of the swallowed needle was reconstructed: from esophagus and stomach, through diaphragm and pericardium up to the left heart ventricle, where the needle was found at the autopsy. The case is very interesting and unique: there has been no similar case described in medical literature so far.

Self-inflicted intramyocardial injury with a sewing needle: a rare cause of pneumothorax

An unusual case of a self-inflicted intracardiac injury with a sewing needle caused a pneumothorax. Fewer than ten cases of needles in the heart have been reported in the recent medical literature; none of these cases was associated with presence of a pneumothorax. The literature regarding self-inflicted injury with needles in the heart is reviewed.