Medical practice

Swallowed pen found after 25 years

There has been a flurry of internet news over the bizarre case of a woman who had a pen removed from her stomach, 25 years after she swallowed it. Amazingly, the plastic pen still worked after over two decades lodged inside her.

The case has been described in the British Medical Journal Case Reports, which explains in detail how the 76-year-old woman was referred for urgent investigation after she developed sudden weight loss and diarrhoea. While performing a CT scan to look at her abdomen, doctors found the startling sight of the felt-tip pen, which they then surgically removed.

Apparently, years earlier the woman had been looking at her tonsils in the mirror but slipped and accidentally swallowed the pen. Both her husband and GP had dismissed her claim at the time as the pen failed to show up on an X-ray. This rather unique case report highlights that just because a patient’s account is unlikely, it does not mean that it is not true.

It is not advisable to examine your tonsils with a pen unless you prefer keeping it in your stomach rather than a pencil case.

How did this happen?

The woman reported that she had been examining a spot on her tonsil with the pen when she accidentally slipped and swallowed the pen by mistake. She said that she had told her GP and husband, but her story had been dismissed after an abdominal examination at that time appeared normal.

Did she have any health problems?

It seems the pen had happily sat in her stomach for over two decades without causing any health problems, but may have eventually led to the diarrhoea and weight loss that caused her to go and see her doctor. Once discovered, the doctors decided to take the pen out despite it having been there for so long: they thought it best to be cautious as there has been at least one case report of a pen that had caused perforation to the intestines as it passed through.

Is this case unusual?

The BMJ Case Reports journal has recently reported at least two other cases of people who have experienced medical problems after swallowing objects that have not shown up on X-ray. These cases highlight the need to perform additional CT scans if the patient can remember swallowing something that may have caused the problem.

  • Earlier this year, the journal published details of a woman who had gone to A&E with a sharp, painful sensation in her throat after eating a lamb casserole. The pain became worse when she swallowed and radiated to her chest and between her shoulder blades. The doctors initially performed an X-ray, but found no sign of a foreign body, leading them to try a CT scan. They found that a triangular 2cm by 2cm lamb bone had lodged in her food pipe close to her spine, just 2mm from a major artery. Doctors removed the bone using forceps and the woman went on to make a complete recovery.
  • Another recent BMJ report describes how a man swallowed the cap of his USB memory stick, which he was holding in his mouth while working on his computer. After swallowing the cap the patient developed an obstruction in his intestine and underwent surgery to remove it. Through this process it was subsequently discovered that the patient had Crohn’s disease. In the discussion of the case it was said that between 80% and 93% of ingested foreign bodies that reach the stomach ‘pass through uneventfully’. They said that the man’s pre-existing intestinal disease may have predisposed him to complications such as obstruction, and a retained foreign body should alert doctors that the patient may have an undiagnosed bowel abnormality. Although the process allowed a diagnosis of this medical problem, Behind the Headlines does not condone the consumption of items of office stationery such as pens and the caps of USB sticks. The article does not state whether the USB stick declined in performance as a result of being exposed to the elements.

These case reports highlight what it is possible to swallow, and also the importance of telling your doctor, if you have swallowed something accidentally.

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