Liver perforation following foreign body ingestion: an important clinical lesson

Abstract

A 25-year-old woman presented to the surgical unit with a 1-week history of ingestion of a pen. Examination revealed a minimally tender epigastrium with no peritonism. Investigations were unremarkable, with normal bloods and no free air on erect chest radiograph. At the time of endoscopy, the pen appeared to have perforated the lesser curve of the stomach. Endoscopic extraction was abandoned and a CT arranged, revealing the tip of the pen lying within the left lobe of the liver. The pen was removed at laparotomy with an uneventful recovery. This case highlights the importance of considering the potential for injury to other structures following gastric perforation, and the importance of having a low threshold for further imaging.

A pen in the liver

“…These included anxiety, depression and emotionally unstable personality disorder (present case), schizophrenia, alcohol misuse disorder, self-mutilation, obsessive water drinking and pica [3] , and schizoaffective disorder and substance use disorder [5] . No mention of mental illness was made in the fourth case [4] .…”

“…The second pen was thought to have passed spontaneously. A 25-year-old woman presented one week after ingesting a pen [4] . The pen was visible in the stomach on abdominal X-ray.…”

Occurrence of multiple fistulas decades after ingestion and neglect of numerous thermometers: a case report

“…5 ) endoscopy is recommended in uncomplicated cases with ingested foreign bodies in the upper GI tract (gastrointestinal tract). If perforation is suspected, endoscopy failed, or other complications occur, surgery should be initiated immediately [ 10 , 11 ]. Such difficult and unusual cases require a close interdisciplinary communication and collaboration between gastroenterologists and surgeons.…”

A toothpick inside the liver with no defined access: A rare cause of liver abscess

“…All people may swallow FBs by accident. However, there are categories of people who are prone to FB ingestion: children [10] , patients with mental health disorders [11] , alcoholics, and palatal insensitivity patients. Furthermore, like this case, most patients cannot recall the incident of swallowing the FB.…”