Abdominal foreign body migration causing cardiac tamponade: A case report

Abstract

Chronic asymptomatic retention of an intragastric foreign body can pose a life-threatening scenario. In the event of migration, it may result in perforation, as shown in our unique case of pericardial perforation through the fundus. Beyond illustrating a rare condition, this case prompts us to engage in a debate about whether to retain or remove asymptomatic foreign bodies in the gastrointestinal tract. It is a 28-year-old male patient, a prisoner, with a history of recurrent foreign body ingestion leading to five previous interventions, presented a year ago to our emergency department after ingesting four metal rods. Despite recommendations, the patient refused the intervention. After 1 year, he presented to our emergency department for respiratory distress. On examination, he had tachycardia, cardiac auscultation revealed a high-pitched sound signing a pericardial knock and abdominal palpation revealed epigastric tenderness. An abdominal X-ray revealed the presence of metallic foreign bodies located in the gastric area. An electrocardiogram showed a low voltage. Given these findings, there was a strong suspicion of rod migration from the stomach to the thoracic cavity with a cardiac tamponade. An emergency CT scan revealed that the rod had pierced through the stomach and pericardium, causing pericardial effusion. The patient was promptly transported to the operating room to discover the tip of the rod out of the stomach and penetrating the left diaphragm and the pericardial layer. The foreign body was removed.