A 62-year-old man visited our hospital emergency room with dizziness and diaphoresis. He received an acupuncture treatment on the subxyphoid area (lower 2 cm and left 1 cm point from the lower xyphoid process border) directly an hour ago because of facial numbness. He had a history of cerebral infarction and permanent atrial fibrillation on warfarinization (2 mg warfarin per day). Surprisingly, the acupuncture needle () was still sticking into his substernum. The initial vital signs were blood pressure of 80/50 mm Hg and heart rate of 110 beats/min. We instantly removed the needle, but he went into cardiac arrest and was rescued within 10 minutes after cardiopulmonary resuscitation. At that time his prothrombin time international normalized ratio was 1.99, therefore, we administered 2 pints of fresh frozen plasma and 5 mg of vitamin K. The transthoracic echocardiography revealed pericardial effusion with early diastolic collapse of the right ventricle. We performed emergent pericardiocentesis using a subcostal approach. After drainage of 500 mL of sanguineous effusion, the patient stabilized hemodynamically. Two hours later, however, the drainage of pericardial effusion persisted up to the total amount of 1000 mL, and the cardiac arrest redeveloped. After resuscitation, an emergent operation was performed under cardiopulmonary bypass (CPB). A median sternotomy allowed visualization of huge hematomas over right atrium and ventricle (). After we evacuated the hematomas, a pumping of acute marginal branch of the right coronary artery was identified. The vessel was torn into pieces, and it was ligated with 4-0 Prolene suture, thereby leading to termination of bleeding (). The aortic cross clamp time was 25 minutes and CPB time was 45 minutes. Thereafter, the patient showed hemodynamically stable vital signs and uneventful condition. Finally he was discharged without any complications.
A 2-year-old female patient with history of sewing needle ingestion about three months back followed by mild intermittent abdominal pain. The child was followed in another hospital for but the foreign body was not expelled spontaneously. A plain abdominal X-ray on arrival showed a radiopaque foreign body (sewing needle) in the lower abdominal quadrant on the midline (). The foreign body was palpable by rectal examination; however, it could not be observed by proctoscopy performed under general anesthesia. Thus, considering that the foreign body might have migrated outside of the lumen, a mini-laparotomy procedure was performed. The sewing needle was observed in the sigmoid mesocolon and removed by opening a small window into the mesocolon (). Child had a recovery and no problems were observed during the 3-month follow-up of the patient.