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

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.

Undiagnosed Accidental Blister Pack Pill Ingestion in Elderly

“…Medicines manufactured by pharmaceutical companies are usually packaged in sets of 10 pills together in blister pack strips made up of aluminum sheets, which do not have sharp edges and corners, but when pharmacists cut these strips to give medicines according to patients' need, the cut sides of blister packs become sharp, pointed, thin, and edgy, and become a potential risk object if swallowed. Ingestion of a BPP is unusual, and its sharp and pointed edges make perforation a possible complication as they pass through the gastrointestinal tract [ 2 , 6 ], although few cases of obstruction have also been reported in the literature [ 4 , 7 ].…”

A folded‐blister pill pack causes ileal perforation

“…Inadvertent ingestion of a blister pack is a rare cause of bowel perforation in <1% of the accidental ingestion of a foreign body . Among the sites of perforation, the ileum accounts for approximately two thirds of all intestinal perforations by a blister pack . Although a blister pack is typically radiolucent, CT is a promising tool to detect the ingested pack.…”

Adult With Multiple Ingested Foreign Bodies Within the Large Bowel

“…Foreign body (FB) ingestion is among the commonest emergencies in gastroenterology-endoscopy; this is often involuntary in adults and may be voluntary in psychiatric patients, drug abusers, and elderly and children. [1][2][3][4][5][6][7][8][9][10][11][12][13] The estimated male to female ratio of this phenomenon is 1.5:1, and the FBs differ among the age groups. 1,2,10 The BFs pass beyond the esophagus and resolve spontaneously in up to 90% of cases; the others impact on some segment of the gastrointestinal tract and require interventions.…”

“…1,2,10 The BFs pass beyond the esophagus and resolve spontaneously in up to 90% of cases; the others impact on some segment of the gastrointestinal tract and require interventions. [1][2][3][4][5][6][7][8][9][10][11][12][13] However, the morbidity and mortality associated with impacted FBs is significant. 2,4,7,11 The commonest sites of impaction are: upper, middle and lower esophagus; stomach; angle of Treitz; ileocecal valve, and appendix.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] However, the morbidity and mortality associated with impacted FBs is significant. 2,4,7,11 The commonest sites of impaction are: upper, middle and lower esophagus; stomach; angle of Treitz; ileocecal valve, and appendix. 1,2,4,[4][5][6][7][8][10][11][12][13] Main clinical manifestations are: odynophagia, dysphagia, globus pharynges, vomiting, and abdominal pain.…”