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Wong MF, Ho MP. Comment on life-threatening esophageal perforation due to blister pack ingestion. Am J Emerg Med 2024; 84:186. [PMID: 36737377 DOI: 10.1016/j.ajem.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/22/2023] [Indexed: 01/27/2023] Open
Affiliation(s)
- Mei-Fwa Wong
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Rico F, Sbar A, Lung J. Small Bowel Perforation Secondary to Blister Pill Pack Ingestion: A Case Report. Cureus 2022; 14:e23895. [PMID: 35530831 PMCID: PMC9076160 DOI: 10.7759/cureus.23895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/28/2022] Open
Abstract
We present a case of accidental ingestion of a foreign body-blister pill pack (FB-BPP) causing small bowel perforation in a patient taking aspirin and clopidogrel due to past history of coronary artery disease. A 71-year-old male presented in the emergency department (ED) with a two-day history of abdominal discomfort and loss of consciousness. His relevant home medication included aspirin and clopidogrel secondary to a history of coronary artery stents. Initial workup with emergent CT scan of abdomen/pelvis with intravenous contrast showed a loop of the terminal ileum with thickened wall and perforation. Incidentally, he was also found to have type II myocardial infarction. Emergent laparoscopic ileocecectomy with primary anastomosis was done. The postoperative course was unremarkable. The pathology report of the small bowel was consistent with a FB-BPP associated perforation. FB-BPP ingestion with perforation is a rare occurrence. It occurs more often in the elderly with significant mortality. Our case of accidental ingestion of FB-BPP was confirmed retrospectively after histopathological evaluation, and complicated by type II myocardial infarction. Emergent laparoscopic bowel resection was done despite significant preoperative risks.
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Affiliation(s)
- Ferdinand Rico
- Department of Surgery, Division of Trauma, Acute Care Surgery, Surgical Critical Care and General Surgery, Mohawk Valley Health System - St. Elizabeth's Hospital, Utica, USA
- Department of Specialty Medicine, University of New England, College of Osteopathic Medicine, Biddeford, USA
| | - Alan Sbar
- Department of Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - John Lung
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, USA
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Wu YH, Ho MP. Comment on secondary peritonitis as a result of accidental ingestion of a press-through package. Geriatr Gerontol Int 2020; 21:278. [PMID: 33336503 DOI: 10.1111/ggi.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yuan-Hui Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Fleres F, Ieni A, Saladino E, Speciale G, Aspromonte M, Cannaò A, Macrì A. Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature. World J Clin Cases 2018; 6:384-392. [PMID: 30283801 PMCID: PMC6163132 DOI: 10.12998/wjcc.v6.i10.384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/26/2018] [Accepted: 08/26/2018] [Indexed: 02/05/2023] Open
Abstract
The accidental ingestion of a foreign body (FB) is a relatively common condition. In the present study, we report a peculiar case of rectal perforation, the first to our knowledge, caused by the inadvertent ingestion of a blister pill pack. The aim of this report is to illustrate the difficulties of the case from a diagnostic and therapeutic viewpoint as well as its unusual presentation. A 75-year-old woman, mentally impaired, arrived at our emergency department in critical condition. The computed tomography scan revealed a substantial abdominopelvic peritoneal effusion and free perigastric air. The patient was therefore submitted to an urgent exploratory laparotomy; a 2-cm long, full-thickness lesion was identified in the anterior distal part of the intraperitoneal rectum. Hence, we performed a Hartmann's procedure. Because of her critical condition, the patient was eventually transferred to the Intensive Care Unit, where she died after 10 d, showing no surgical complication. The ingestion of FBs is usually treated with observation or endoscopic removal. Less than 1% of FBs are likely to cause an intestinal perforation. The intestinal perforation resulting from the unintentional ingestion of an FB is often a difficult challenge when it comes to treatment, due to its late diagnosis and the patients' deteriorated clinical condition.
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Affiliation(s)
- Francesco Fleres
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina, Messina 98125, Italy
| | - Antonio Ieni
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of Anatomic Pathology, University of Messina, Messina 98125, Italy
| | - Edoardo Saladino
- General and Oncologic Surgery Unit, Clinica Cappellani-GIOMI, Messina 98168, Italy
| | - Giuseppe Speciale
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of Anatomic Pathology, University of Messina, Messina 98125, Italy
| | - Michele Aspromonte
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina, Messina 98125, Italy
| | - Antonio Cannaò
- Messina University Medical School Hospital, Messina 98125, Italy
| | - Antonio Macrì
- Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, Messina University Medical School Hospital, Messina 98125, Italy
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An unusual case of duodenal perforation caused by a blister pack: A case report and literature review. Int J Surg Case Rep 2015; 14:129-32. [PMID: 26263453 PMCID: PMC4573598 DOI: 10.1016/j.ijscr.2015.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 12/13/2022] Open
Abstract
Unnoticed ingestion of blister packs cause gastrointestinal perforation. Preoperative diagnosis of foreign body ingestion is often difficult. Duodenal perforation caused by blister packs is extremely rare. Perforation in the third portion of duodenum can lead to retroperitoneal abscess. Despite prompt management, duodenal perforation may be potentially fatal. Introduction Ingestion of foreign bodies is a relatively common clinical problem. Blister packs have been known to be a causative agent of gastrointestinal perforation. We report a rare case of duodenal perforation caused by a blister pack, which was complicated by retroperitoneal abscess and having a poor outcome. Presentation of case A 72 year-old man with a history of dementia presented to the emergency department with a 2-day history of backache. Upon radiological findings, perforated peptic ulcer was suspected. However, emergency laparotomy revealed a blister pack protruding from the posterior wall of the third portion of the duodenum. It was complicated by a widespread retroperitoneal abscess. After removal of the foreign body, the perforation was treated with primary suture repair and an omental patch. However, the patient died two days after operation due to sepsis. Discussion According to a literature review, the ileum is the most common site of perforation caused by blister packs. To our knowledge, duodenal perforations have not been documented to date. Curative treatment often involves emergent surgery. However, duodenal perforation in the third portion may lead to retroperitoneal abscess, which can result in severe sepsis and have a poor outcome. As there is no consensus about an ideal surgical approach, retroperitoneal abscess is one of the clinical challenges for surgeons. Even with prompt management, duodenal perforation may become fatal. Conclusion Unnoticed ingestion of blister packs can cause duodenal perforation. Although prompt management is necessary, duodenal perforation, especially in the third portion, may be potentially fatal.
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Orry X, Balaj C, Lecocq S, Blum A, Delvaux M, Régent D, Claudon M, Laurent V. CT diagnosis of small bowel perforation by ingestion of a blister pack: two case reports. Diagn Interv Imaging 2013; 95:101-3. [PMID: 23726172 DOI: 10.1016/j.diii.2013.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- X Orry
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - C Balaj
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - S Lecocq
- Imagerie Guilloz, Hôpital central, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - A Blum
- Imagerie Guilloz, Hôpital central, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - M Delvaux
- Department of Hepato-Gastroenterology, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - D Régent
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - M Claudon
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - V Laurent
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
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A pill for cholesterol and a capsule for bleeding. Dig Liver Dis 2012; 44:e20. [PMID: 22520232 DOI: 10.1016/j.dld.2012.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 02/23/2012] [Accepted: 03/01/2012] [Indexed: 12/11/2022]
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Ho MP, Tsai KC, Chang WH. Gastric ulcer bleeding caused by press-through package mis-swallowing. J Am Geriatr Soc 2012; 60:1366-7. [PMID: 22788393 DOI: 10.1111/j.1532-5415.2012.04014.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Domen H, Ohara M, Noguchi M, Nakanishi Y, Komuro K, Iwashiro N, Ishizaka M. Inadvertent Ingestion of a Press-Through Package Causing Perforation of the Small Intestine within an Incisional Hernia and Panperitonitis. Case Rep Gastroenterol 2011; 5:391-5. [PMID: 21792348 PMCID: PMC3142101 DOI: 10.1159/000330290] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A 90-year-old woman was admitted to the emergency department of our hospital with abdominal pain and a fever of up to 39°C. She had a history of hysterectomy about 30 years previously, and redness and swelling were seen at the abdominal median scar. Serum biochemistry showed minor elevation of C-reactive protein and creatine phosphokinase. Abdominal computed tomography (CT) showed an edematous intestinal tract image over the median abdominal wall. Incarcerated incisional hernia and intestinal necrosis were suspected. Therefore, emergency surgery was performed. On laparotomy, abundant purulent ascitic fluid was found. The small intestine was incarcerated about 100 cm orally from the terminal ileum, and a 2-mm perforation was present in the incarcerated small intestine. In addition, some white areas measuring 1 mm were found in the small intestinal wall. A press-through package (PTP) of a tablet was confirmed in the intestinal tract near the perforated area. We removed the PTP through the perforation and performed direct suture. Postoperatively, we retrospectively reviewed the CT image and found a high-density shadow which seemed to represent the PTP.
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Affiliation(s)
- Hiromitsu Domen
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
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Images in emergency medicine. Press-through package mis-swallowing. Ann Emerg Med 2008; 52:98, 115. [PMID: 18655920 DOI: 10.1016/j.annemergmed.2007.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 10/30/2007] [Accepted: 11/05/2007] [Indexed: 11/27/2022]
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Tadic M, Kujundzic M, Babic Z, Banic M, Vukelic-Markovic M, Curic J. Acute lower gastrointestinal bleeding after ingestion of blister-wrapped tablet. Am J Gastroenterol 2007; 102:2863-5. [PMID: 18042122 DOI: 10.1111/j.1572-0241.2007.01528_7.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Yamamoto T, Hirohashi K, Iwasaki H, Kubo S, Tanaka Y, Yamasaki K, Koh M, Uenishi T, Ogawa M, Sakabe K, Tanaka S, Shuto T, Tanaka H. Pseudotumor of the omentum with a fishbone nucleus. J Gastroenterol Hepatol 2007; 22:597-600. [PMID: 17376061 DOI: 10.1111/j.1440-1746.2006.03353.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 23-year-old Japanese man was admitted with a chief complaint of abdominal pain. He was previously healthy, and his past medical history was unremarkable. Local tenderness and rebound tenderness at McBurney's point were elicited. Abdominal roentgenography was non-diagnostic. Ultrasonography and computed tomography showed a tumor with a central core. Based on a diagnosis of appendicitis with omental inflammation or an omental tumor, laparotomy performed. Intraoperatively, no site of gastrointestinal perforation was detected; however, a 5-cm omental granuloma was identified that proved to have a fishbone nucleus on pathological examination. The postoperative course was uneventful, and upper gastrointestinal endoscopy and barium enema were unremarkable. A large solitary omental pseudotumor is rare, and the clinical course in this case was atypical compared with the usual course of intestinal perforation by a foreign body and formation of an intra-abdominal granuloma.
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Abstract
A press through package (PTP) is commonly used as a package for drugs and also being seen increasingly in cases of foreign body in the digestive tract. We presented three cases of inadvertent PTP ingestion with a variety of clinical presentations. Although commonly considered to be small and soft to cause bowel damage, a PTP tends to be caught and poses potential risk for perforation of the bowel because of its sharp edges. The PTP material is thought to be difficult to detect on plain abdominal roentgenography due to its radiolucency. However, air trapped in the PTP makes the drug tablet possibly visible on the radiograph. All of the three cases were diagnosed with correct interpretation of these special radiographic findings, even without the recall of accidental swallowing of the tablet. A PTP in the oesophagus and stomach should be tried to be removed, while computerised tomography and early laparotomy should be considered when it passes through the pyloric ring and the patient develops symptoms. An effort to prevent the PTP swallowing should be an essential part in our everyday practice, especially for the elderly patients.
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Affiliation(s)
- Sen-Kuang Hou
- Emergency Department,Taipei Veterans General Hospital, Institute of Emergency and Critical Care Medicine, Taiwan, ROC
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Ishikura H, Sakata A, Sakaki Y, Kimura S, Sumi T, Ichimori T, Uyama K. Intestinal perforation due to ingestion of blister-wrapped tablet in a press-through package. Am J Gastroenterol 2003; 98:1665-6. [PMID: 12873609 DOI: 10.1111/j.1572-0241.2003.07560.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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