Background: Safety-pin ingestion causing cardiovascular complications are very rare with high risk for mortality.

Case Characteristics: A 10-month-old child who presented with persistent irritability and intermittent fever of 1 month duration. The child had tachypnea and mild subcostal retractions.

Observation: Investigations revealed open safety-pin in lower esophagus, and pericardial effusion that later progressed to cardiac tamponade during handling of the safety pin by endoscope.

Message: It may be safer to drain pericardial collection before handling sharp foreign bodies in lower end of esophagus as it can worsen cardiac complications.

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