{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:37Z","timestamp":1756425817855,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,7,21]]},"abstract":"<jats:p>A 52-year-old woman presented to the accident and emergency department 5\u2005h after deliberately stabbing herself with two pens through her midline laparotomy scar. Her medical history included an emotionally unstable (borderline) personality disorder and she was currently an inpatient in a psychiatric hospital. She had multiple accident and emergency attendances with previous episodes of self-harm. Clinical examination revealed evidence of trauma to her midline laparotomy scar with congealed blood covering the puncture site. Her abdomen was soft and non-tender on palpation. A chest radiograph revealed no air beneath her diaphragm and her abdominal radiograph identified a radiopacity in her upper right abdomen and dilated loops of small bowel. CT of the abdomen and pelvis confirmed two pens, with the lower pen tip reaching the pancreas. A midline laparotomy was performed and both foreign bodies were extricated unremarkably. The patient's postoperative recovery was uneventful. The second case involves a 22-year-old woman, a psychiatric hospital resident, presenting to the accident and emergency department 5\u2005h after deliberately inserting the metal nib and inner plastic ink containing tube of a pen through her umbilicus. Her medical history included an emotionally unstable (borderline) personality disorder and paranoid schizophrenia. She had multiple accident and emergency department attendances with previous episodes of self-harm. Clinical examination revealed a soft, non-tender abdomen. Her chest radiograph was unremarkable and her abdominal radiograph identified a radiopaque foreign body at the right upper quadrant of the abdomen. CT of the abdomen and pelvis confirmed a metallic foreign body in the small bowel mesentery. An exploratory laparotomy converted to a midline laparotomy was performed and the foreign body was extricated. The patient's postoperative recovery was uneventful.<\/jats:p>","DOI":"10.1136\/bcr-2015-209954","type":"journal-article","created":{"date-parts":[[2015,8,5]],"date-time":"2015-08-05T08:57:24Z","timestamp":1438765044000},"page":"bcr2015209954","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Foreign bodies in the abdomen: self-harm and personality disorders"],"prefix":"10.1136","volume":"2015","author":[{"given":"Louise","family":"Dunphy","sequence":"first","affiliation":[{"name":"Department of Surgery, Milton Keynes University Hospital, Buckinghamshire, Milton Keynes, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farah","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Surgery, Milton Keynes University Hospital, Buckinghamshire, Milton Keynes, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mazhar","family":"Raja","sequence":"additional","affiliation":[{"name":"Department of Surgery, Milton Keynes University Hospital, Buckinghamshire, Milton Keynes, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,8,5]]},"reference":[{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.3.5982.527"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.2","first-page":"226","article-title":"Foreign body in the bladder: report of 4 cases","volume":"13","author":"Elhams","year":"2007","journal-title":"Afr J Urol"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.3","doi-asserted-by":"publisher","DOI":"10.1097\/00000433-199503000-00010"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.4","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.48.2.162"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.5","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.1994.8.4.257"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.6","unstructured":"Clarkin J , Yeomans F , Kernberg O . Psychotherapy for borderline personality disorder. Washington DC: American Psychiatric Publishing, 2006."},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.7","doi-asserted-by":"crossref","unstructured":"Bateman A , Fonagy P . Psychotherapy for borderline personality disorder. New York, NY: Oxford University Press, 2004.","DOI":"10.1093\/med:psych\/9780198527664.001.0001"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.8","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1991.01810360024003"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.9","unstructured":"Young JE . Cognitive therapy for personality disorders: a schema-focused approach. Sarasota, FL: Professional Resource Pack, 1999."},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.10","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.154.8.1101"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.11","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.11.2018"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.12","first-page":"277","article-title":"Childhood trauma in borderline personality disorder","volume":"151","author":"Herman","year":"1989","journal-title":"Am J Psychiatry"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.13","unstructured":"DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: 4th edition. American Psychiatric Association; 2000."},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.14","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(85)90178-0"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.15","doi-asserted-by":"publisher","DOI":"10.1159\/000029088"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.16","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1947-8-391"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0210-5705(03)70521-4"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.18","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198302000-00020"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.19","first-page":"PCC11F01192","article-title":"Insertion of foreign bodies (polyembolokoilamania): underpinnings and management strategies","volume":"14","author":"Unruh","year":"2012","journal-title":"Prim Care Companion CNS Disord"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.20","first-page":"119","article-title":"International ingestion and insertion of foreign objects: a forensic perspective","volume":"40","author":"Klein","year":"2012","journal-title":"J Am Acad Psychiatry Law"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.21","unstructured":"NICE guidelines. Borderline personality disorder: treatment and management. http:\/\/www.nice.org.uk\/guidance\/CG78"},{"key":"2025082802481658000_2015.aug05_1.bcr2015209954.22","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.53.3.348"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2015-209954","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:48:26Z","timestamp":1756374506000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2015-209954"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,8,5]]},"references-count":22,"alternative-id":["10.1136\/bcr-2015-209954"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2015-209954","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2015,8,5]]}}}