Case Presentation: A 35-year-old male with a history of schizophrenia, bipolar disorder, and methamphetamine abuse presented to the ED with chest pain. The patient had a long history of inserting 5cm long sewing needles into his body with the belief that this would improve his health. He stated that he had placed a needle in his chest because of chest discomfort to “help to heal the heart attack”. CT chest performed at that time demonstrated a metallic foreign body in the left ventricle as well as multiple radiopaque foreign bodies (needles) within the soft tissue of the anterior abdomen including the anterior peritoneal cavity with the tip adjacent to the mid transverse colon His CBC, CMP, and LFTs were unremarkable. Troponin was 0.847 and EKG showed Sinus rhythm with occasional premature ventricular complexes. Patient was started on beta blocker and monitored on telemetry, and CT was obtained which showed a 5.8 cm straight sewing needle present within the left ventricle and extending from the anterior apical myocardium with trace pericardial effusion. Cardiology was consulted for emergent Echocardiogram which indicated that the needle had tracked into the left ventricle. Cardiothoracic surgery offered emergent surgery for needle removal but the patient declined. Psychiatry and the Ethics Board were consulted and the patient was deemed non-decisional. 5 days after admission, the patient underwent open heart surgery to remove the needle. He successfully recovered and was discharged to the behavioral health inpatient ward.
Discussion: This is a rare presentation of an intentional self-inflicted sewing needle that tracked into and penetrated the left ventricle. There are less than 50 similar cases reported. Foreign bodies to the heart present possible life-threatening complications that need emergent surgical intervention. It is still worth considering the ethical complications as well. In this case, the patient’s autonomy was called into question. While the patient denied any suicidal ideation, he was deemed non-decisional due to self-injurious behavior, and the surgery proceeded.
Conclusions: This case presents a rare complication of an intentional self-inflicted sewing needle placed into the chest. While the management of this case was ultimately surgical intervention, this case had clinical, ethical, and decisional capacity implications that are common for the Hospitalist Provider.