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Bic PenFrom: ainsron@msn.comFri Dec 22 15:49:49 2000
Interesting what happens when people get too much holiday cheer. I was called to assist a urologist in the OR today, a 41 yo WF came in to the ER early this AM with a blood alcohol of 0.15 and apparently while she was passed out, her friend/lover/partner pushed a Bic pen up "the small hole." She was having a fair amount of pain, afebrile, with a WBC of 15,000. The urologist initially did a cystoscopy and couldn't find a hole in the bladder. An abdominal flat plate showed the foreign body somewhere in the abdominal cavity. Because they didn't initially find a bladder perforation, a gastroenterologist was called in and a air contrast BE performed which did not show anything in the colon. She was next taken to the OR and I was called at this point to help look for the pen. We found it floating freely among the loops of small bowel and about 500 cc of the irrigant used for the cystoscopy which was within the peritoneal cavity. The pen was easily retrieved with a babcock forceps through a 10mm port and removed. There was no bleeding from the now easily identified opening into the dome of the bladder, as we filled her bladder with saline and watched it leave the bladder. The plan is to cover her with antibiotics for a few days, drain the bladder with a Foley for 5-7 days.
-- Ronald E. Ainsworth, MD
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