Inadvertent Ingestion of a Press-Through Package Causing Perforation of the Small Intestine within an Incisional Hernia and Panperitonitis

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.

Aspiration of a drug in a blister pack

“…Cases of accidental swallowing of PTPs have been reported previously . The swallowed PTPs can cause perforations of the digestive tract . In contrast, the presence of PTPs as airway foreign bodies is quite rare, and to the best of our knowledge, only one case of a PTP in the upper airway has been reported .…”

Multiple intestinal perforations due to blister pill pack ingestion

“…Endoscopic extraction may be considered when they are found in the upper GI tract, and surgery will remain imperative when perforation occurs 10. A complete clinical history is crucial when a high index of suspicion over true accidental ingestion of an FB is present, being this the main focus point when dealing with these cases.…”

Press‐through package mis‐swallowing: Usefulness of computed tomography

“…4 Therefore, it is very important to make an early and correct diagnosis of the location of the PTP. However, PTP material is difficult to detect directly on plain radiography due to its high radiolucency, and the timing and validity of computed tomography (CT) examinations have not been established.…”

“…[1][2][3] Endoscopic removal should be carried out in cases involving PTPs in the esophagus or stomach, and early laparotomy should be con-sidered if the material passes through the pyloric ring, causing symptoms. 4 Therefore, it is very important to make an early and correct diagnosis of the location of the PTP. However, PTP material is difficult to detect directly on plain radiography due to its high radiolucency, and the timing and validity of computed tomography (CT) examinations have not been established.…”