Obstruction and perforation of the small bowel caused by inadvertent ingestion of a blister pill pack in an elderly patient

Al-Ramahi, Ghassan; Mohamed, Mohamed A; Kennedy, Kristin; McCann, Michael T.

doi:10.1136/bcr-2015-212822

Cited by 12 publications

(15 citation statements)

References 13 publications

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“…Approximately 80%-90% of ingested FBs pass through the GI tract with no complication, whereas the remaining 10%-20% fail to progress. Less than 1% of FBs can determine an intestinal perforation[ 3 ]. Small orthodontic appliances and dentures account for 73% of the FBs accidentally ingested by the elderly.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature

Fleres

Ieni

Saladino³

et al. 2018

WJCC

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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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Section: Discussionmentioning

confidence: 99%

“…In practical terms, a BPP appears as an object with sharp and pointed edges and it can produce a bowel perforation. Therefore, sharp, thin, stiff, pointed or long FBs can cause perforation by direct penetration or by remaining stuck within the lumen, thus provoking necrosis of the bowel wall[ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature

Fleres

Ieni

Saladino³

et al. 2018

WJCC

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“…Foreign body ingestion is mostly seen in children, elderly, psychiatric patients, persons with substance abuse, professionally exposed persons like carpenters, dressmakers, and upholsterers, and sometimes as suicidal attempts. Elderly persons are at increased risk due to a number of confounding factors like poor vision, poor cognitive function leading to dependency on others, intake of higher number of drugs due to advancing age, and associated co-morbidities (polypharmacy) [ 3 , 4 ]. Use of artificial dentures and lack of normal palatal and gingival sensation play an important role in accidental ingestion of BPP in this population group [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed Accidental Blister Pack Pill Ingestion in Elderly

Dwivedi¹,

Singh²,

Ahmad³

2021

Cureus

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Ingestion of foreign body is a common occurrence in children. Most of these foreign bodies pass through gastrointestinal tract without causing any symptom or complication. Sharp edgy objects have propensity to cause tear or damage to the mucosal linings of gastrointestinal tract. Here is an interesting case of unintentional ingestion of blister pack pill in an elderly, whose initial presentation was intestinal obstruction and later on developed intestinal perforation.

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“…Blister-packaging medications require more equipment and time for pharmacies and may cause safety issues or difficulty for patients with low dexterity. [8][9][10] Repacking medication also decreases the expiration date to one year from the date of packaging or sooner, which could cause more wastage. Some pharmacies in Iowa have started dispensing all oral chemotherapy agents in blister packages since the Cancer Take-Away Program started, aiding in the significant increase in returned and reused cancer medications this year.…”

Section: Discussionmentioning

confidence: 99%

Financial impact of oral chemotherapy wastage on society and the patient

Monga

Meyer

Vakiner

et al. 2018

J Oncol Pharm Pract

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Background Targeted oral agents are now increasingly being utilized in cancer treatment, but are expensive. Changing the dose of these medications due to toxicity or discontinuation secondary to disease progression or death causes waste from unused medication. Limiting waste is an important goal, as waste has a substantial financial impact on patients and insurance companies. Methods Patients started on oral targeted agents' sunitinib, everolimus, axitinib, or vemurafenib between January 2012 and February 2015 who obtained their medications at Holden Comprehensive Cancer Center specialty pharmacy were included in the analysis. We acquired dispensing data retrospectively for each of the agents and reviewed patient charts. Wasted tablets/capsules were calculated from their last fill to the dates of stoppage or dose adjustment. The amount associated with the wastage was calculated using the average wholesale price. Repository drug usage data during the same time period was obtained. Results Eighty-eight patients had their prescriptions filled at Holden Comprehensive Cancer Center during the study time period. Waste occurred in 41% of all patients with primary reasons attributed to cancer progression in 25 patients, death in five patients, toxicity in five patients and increase in dosage of targeted therapy in two patients. A total of 1179 tablets or capsules were wasted from all causes, priced at a total of $248,595.69. Conclusion Oral chemotherapy medications are associated with wastage, which is a significant financial burden to society. Progression of disease emerged as the single most important factor accounting for wastage. Novel ideas are needed to prevent wastage, thereby reducing healthcare costs.

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Obstruction and perforation of the small bowel caused by inadvertent ingestion of a blister pill pack in an elderly patient

Cited by 12 publications

References 13 publications

Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature

Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature

Undiagnosed Accidental Blister Pack Pill Ingestion in Elderly

Financial impact of oral chemotherapy wastage on society and the patient

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