Management of a recurrent suicide attempt with needle insertion into the heart; a case report.

INTRODUCTION: Penetrating cardiac injury (PCI) is rare and life-threatening, with complications that include hemorrhage, tamponade, arrhythmia, and cardiac arrest. Needle insertion into the heart is infrequently reported; to our knowledge, only one case of recurrent self-insertion has been described. CASE PRESENTATION: A 29-year-old man with bipolar I disorder and a prior sternotomy for foreign-body removal presented after a second suicide attempt within two years, having self-inserted multiple needles through the chest and abdomen. Chest radiography showed three metallic densities in the left hemithorax and one in the abdominal wall. Transthoracic echocardiography demonstrated a linear metallic echo within the left ventricle (LV) near the apex. Computed tomography confirmed three metallic densities in the left thorax, one penetrating the LV to a depth of 30 mm. Median sternotomy was performed, and one needle was removed from the LV. After recovery, the patient was transferred to a psychiatric hospital for further inpatient treatment. DISCUSSION: Intentional cardiac injury by needle insertion is extremely rare and poses diagnostic and therapeutic challenges. Early imaging and prompt surgery are essential to reduce morbidity and mortality. A multidisciplinary plan, including psychiatric evaluation and follow-up, is required to prevent fatal outcomes and recurrence. CONCLUSION: This study describes the successful management of a penetrating cardiac injury in a patient with a prior sternotomy.