A Case of Repeated Cardiac Trauma Caused by Sewing Needles

Abstract

Here, we report a rare case of repeated cardiac trauma caused by self-harm with sewing needles and a literature review. The patient was a 48-year-old female, who repeatedly self-harmed when stressed by inserting a needle into her anterior chest. She had previously undergone three thoracotomy procedures and more than eight procedures for needle removal. In the current case, she visited the hospital due to persistent chest pain after inserting a needle into her left anterior chest. The needle was buried under the skin and could not be seen externally. Computed tomography revealed a 6 cm-long needle, located 1 cm under the skin reaching the right ventricle. Although the patient was hemodynamically stable with no pericardial effusion, emergency surgery was performed due to the possibility that cardiac motion would advance the needle, penetrating the left ventricle, as well as the possibility of additional cardiac injury. Because of repeated thoracotomies and needle-removal procedures, we expected that the patient would have extensive adhesions in the mediastinum, and there was a high risk of cardiac injury with thoracotomy. Therefore, thoracotomy was performed under cardiopulmonary bypass. We performed the thoracotomy while taking care not to advance the needle by monitoring its tip with transesophageal echocardiography. After confirming the position of the needle penetrating the right ventricle, 4-0 monofilament suture with pledget support was sutured around the needle in a U-shape, and the needle was removed. The procedure was completed after confirming the absence of ventricular septal perforation by transesophageal echocardiography.