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A pen in the liver

Barrie, Jenifer; Lobo, Dileep N.

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Jenifer Barrie

Professor of Gastrointestinal Surgery


A 24-year-old woman with anxiety, depression, and emotionally unstable personality disorder was referred to a tertiary center 2 weeks after ingesting multiple foreign bodies. She had undergone a laparoscopic cholecystectomy and a laparotomy for extraction of ingested foreign bodies several years ago. A sagittal CT scan view showed a ballpen and a hair clip in the stomach. A coronal view demonstrated that a second ballpen had penetrated the duodenal wall to enter the liver parenchyma. There was no free intraperitoneal air or fluid or evidence of abscess formation. At laparotomy, a toothbrush, a broken spoon and a ballpen were extracted from the stomach via an anterior gastrotomy. The duodenum was adherent to the liver but the second ballpen had migrated into the distal duodenum, with the tip in the proximal jejunum. This was extracted via an enterotomy and the fistula was not interfered with. The enterotomy and gastrotomy were closed with 3-0 polydioxanone sutures. The hair clip had passed spontaneously and was not detected on intraoperative fluoroscopy. She made an uneventful recovery and postoperative liver function tests remained in the normal range. This is only the fourth reported case of a pen fistulizing between the upper gastrointestinal tract and the liver.


Barrie, J., & Lobo, D. N. (2022). A pen in the liver. Radiology Case Reports, 17(10), 3992-3995.

Journal Article Type Article
Acceptance Date Jul 27, 2022
Online Publication Date Aug 17, 2022
Publication Date Oct 1, 2022
Deposit Date Oct 14, 2022
Publicly Available Date Oct 14, 2022
Journal Radiology Case Reports
Electronic ISSN 1930-0433
Publisher Elsevier BV
Peer Reviewed Peer Reviewed
Volume 17
Issue 10
Pages 3992-3995
Keywords Radiology, Nuclear Medicine and imaging
Public URL
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