Chronic constrictive pericarditis caused by self-mutilation with sewing needles. A case report and review of published reports.

Abstract

SUMMARY A 34 year old woman with a history of self-mutilation developed severe constrictive pericarditis with sterile, calcified intrapericardial abscess cavities as a result of inserting sewing needles into her chest seven years previously. After pericardiectomy she made a good recovery.In peacetime needles are the most common foreign bodies found in the pericardial sac, whereas bullets and shrapnel become more common in times of war.' In the nineteenth century it became fashionable to attempt suicide by driving a long pin, needle, or skewer into the heart. Admiral Villineuve who commanded the French fleet at Trafalgar was taken prisoner by the English. After his release he returned to Rennes from where he sent a message to Napoleon announcing his return to French soil. Suffering from guilt and depression, and failing to receive a reply from Napoleon, whom he knew to be more than a little displeased, he killed himself by driving a long needle six times into his heart. In 1868 Fischer described 452 patients wounded in the heart or great vessels and showed that such wounds were not always fatal.2 He recorded 319 penetrating wounds, mainly stab and gunshot, but 44 were puncture wounds. Of these, 28 were caused by various types of needles and only 10 patients survived the initial injury.In 1899 Loison reported a further series of 61 penetrating injuries; in 23 cases these were caused by needles. Some of these patients were symptomless while others died suddenly for unknown reasons.3 Fourteen (61 %) died; eight of haemorrhage with tamponade, and one of infection. In five the cause of death was not known.

The Diagnosis and Surgical Management of Intracardiac Quill Foreign Body in a Dog

“…4,16 This finding is consistent with human literature where patients who survive removal of a foreign body have a good prognosis if there is not extensive trauma to the heart. [18][19][20][21][22]…”

Self-Inserted Needles in the Heart

“…Cardiac injuries from sharp penetrating foreign bodies, other than firearms or cutting weapons, have been described in medical reports, 5e7 as frequently related to self-aggressive behavior in subjects with mental disorders, such as schizophrenia, major depression, mania, and gender identity disorders. 8,9 In a retrospective analysis of cases of foreign bodies in the heart, most were due to transthoracic insertion, whereas others resulted from migration through bloodstream from a variety of distant sites. Few cases have involved multiple needles.…”

An Asymptomatic Needle in the Left Ventricular Anterolateral Wall: A Prison Inmate's Strange Radio Antenna

“…Currently, there are no guidelines for the treatment of a needle localized in the heart; it is thought that surgery should not be delayed to minimize future complications 2 . Although early surgery is often recommended, some authors believe that surgery should be avoided as long as no dangerous manifestations are present 3 . If the needle is embedded in the myocardium after entering the heart through the thorax, the risk of complications is lower than for extracardiac cases 4 .…”