Transesophageal migration of a turban pin with left ventricular myocardial penetration.

Abstract

Ingestion of sharp metallic objects is associated with perforation and, rarely, migration into the mediastinum or heart. Migration of a pagri (turban) pin into the left ventricle (LV) has not been previously reported. A 20-year-old Sikh male presented with dysphagia after swallowing two turban pins. He was hemodynamically stable and radiographs demonstrated two metallic foreign bodies. Endoscopic removal retrieved one pin, but the second was not visualized. High-resolution non-contrast computed tomography (CT) revealed the residual pin tracking from the esophagus to the pericardium near the LV apex. Echocardiography confirmed its presence within the myocardium, associated with a small localized hemopericardium but no tamponade. Through a left anterolateral mini-thoracotomy in the 6th intercostal space, a 4-cm pin was extracted from the LV epicardial surface. The pericardium was left open, a pleural drain placed, and the patient extubated on the table. He received broad-spectrum antibiotics (ceftriaxone and vancomycin). The drain was removed on day 2 and he was discharged on day 3. Follow-up echocardiography was normal. This case highlights the importance of multimodality imaging when a sharp ingested foreign body is not recovered endoscopically. Timely surgical removal via limited thoracotomy can achieve excellent outcomes even in rare instances of myocardial penetration.