Undiagnosed Accidental Blister Pack Pill Ingestion in Elderly

Dwivedi, Priyanka; Singh, Gaurav; Ahmad, Sajjad

doi:10.7759/cureus.17167

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…Second, tablet blisters are often difficult to recognize on initial imaging depending on the gating plane [ 5 ]. In the lateral view, the plastic blisters with their aluminum foil closure and the tablets, surrounded by a small air gap, often appear like small “unidentifiable flying objects” [ 6 ]. As in both our cases, blisters can often only be recognized in a retrospective review of the images, with knowledge of the clinical course [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Unintentional Plastic Blister Ingestion Leading to Intestinal Perforation: A Report of Two Cases

Medina Gontier,

Wienandts,

Endermann

2024

Am J Case Rep

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Case series Patients: Male, 75-year-old • Male, 55-year-old Final Diagnosis: Intestinal perforation • mucosal injury Symptoms: Non-specific abdominal discomfort • non-specific symptoms • reduction in vigilance Clinical Procedure: — Specialty: Critical Care Medicine • Gastroenterology and Hepatology • Surgery Objective: Unusual clinical course Background: Unintentional medication-blister ingestion is rare but frequently leads to intestinal perforation. The diagnosis of intestinal perforation following blister ingestion is often delayed because of an unreliable history and non-specific clinical presentation. The purpose of this case report is to raise awareness about a rare but difficult diagnosis and its importance in avoiding potentially fatal events. Case Reports: Herein, we describe successful cases of surgical and endoscopic removal after blister ingestion. The first case was that of a polymorbid 75-year-old man who presented with acute onset of abdominal pain in the right upper quadrant and epigastric regions. No indication of the cause was observed on initial computed tomography (CT). The patient developed an acute abdomen, and emergency laparotomy was performed, during which 2 small perforations were observed in the terminal ileum, and an empty tablet blister was retrieved. The second patient was a 55-year-old man who presented with a considerable lack of awareness. On the initial CT, a subdural hematoma, aspiration, and an unidentified foreign body in the stomach were observed. Gastroscopy was performed after emergency craniotomy. In addition to the initial foreign body, a second object, which had gone unnoticed on the initial CT, was found and removed from the esophagus. Conclusions: With an increased risk of perforation and difficult clinical and radiological diagnoses, prophylactic measures and special awareness of high-risk patients are particularly important.

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Section: Discussionmentioning

confidence: 99%

Unintentional Plastic Blister Ingestion Leading to Intestinal Perforation: A Report of Two Cases

Medina Gontier,

Wienandts,

Endermann

2024

Am J Case Rep

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“…Because of children's different cognitive abilities and anatomical structure, curiosity about new things, rapid intake of food, and the sale of dangerous toys, children are more likely to ingest FBs [8,31]. In addition, some studies have found that bronchial FB inhalation is most likely to occur in infants under 5 years old and elderly individuals, and this kind of FB ingestion has a high death rate [1,32]. Our study also found that the death rate of people 70 and older showed an uptrend, which may be attributed to the aging population.…”

Section: Discussionmentioning

confidence: 99%

“…FBs are a common clinical emergency, that involves people of all ages, especially children under the age of 5 and older adults over 80 years old [ 1 ]. Globally, foreign bodies (FBs), including intraocular foreign bodies (IOFBs), pulmonary aspiration and foreign bodies in the airway (PAFBA), and FBs in other body parts, are any object or substance that unintentionally penetrates the body or its cavities.…”

Section: Introductionmentioning

confidence: 99%

The global, regional, and national burden of foreign bodies from 1990 to 2019: a systematic analysis of the global burden of disease study 2019

Zhan,

Du,

et al. 2024

BMC Public Health

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Background Foreign bodies (FBs) are a common emergency in medical institutions, that can occur in any area and among people of any age, which are common public health problems. Understanding the epidemiological characteristics of FBs is crucial for their prevention and control. The purpose of this study was to analyze the epidemiological characteristics of FBs worldwide through the data from the Global Burden of Disease Study 2019 (GBD 2019). Methods We obtained data from the GBD 2019, which is an important public database to understand the disease burden of FBs. Joinpoint was used to analyze temporal trends in the incidence and death trends of FBs, which is widely used to study the long-term temporal trend of the burden of diseases. SaTScan was used to detect spatial-temporal clusters of pulmonary aspiration and foreign body in the airway (PAFBA), which is based on a Poisson model, scanning the number of people and diseases in the study area to obtain the spatial-temporal clusters of diseases. Results Globally, the age-standardized incidence rate (ASIR) and the age-standardized death rate (ASDR) of FBs in 2019 were 869.23/100,000 (679.92/100,000-1120.69/100,000) and 1.55/100,000 (1.41/100,000-1.67/100,000), respectively. The ASIR and ASDR showed downtrends with average annual percent changes (AAPCs) of -0.31% and − 1.47% from 1990 to 2019. Of note, the ASIR showed an uptrend during 2010–2019, especially in high, high-middle, and middle SDI regions. Stratified analysis by age group showed that ASIR increased in each age group in recent years. From 1990 to 2019, the ASDR in the over-70 age group showed an uptrend worldwide, especially in high and high-middle SDI regions. In different types of FBs, the ASDR of PAFBA was the highest. The death burden of PAFBA was mainly clustered in 82 countries during 1993–2007, such as Canada, Cuba, and Mexico. Conclusion The most important goal is to improve public awareness and emergency knowledge of FBs through publicity methods, such as the internet or offline activities, and to improve laws and regulations. Additionally, different age groups need different targeted measures, such as strengthening the care of children, caring for elderly individuals, improving necessary monitoring programs and reporting systems, conducting effective hazard assessments, and publicity and education activities.

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“… 1 , 2 While complications from foreign body ingestion are rare, occurring in less than 1% of cases, the risk of gastrointestinal perforation increases with sharp or pointed objects like BPs. 3 , 4 , 5 , 6 , 7 Gastrointestinal perforations have been documented in several case reports, involving locations including the esophagus, 8 , 9 , 10 small intestinal, 7 , 10 , 11 , 12 , 13 and rectum, 10 , 14 some of which have been fatal. Therefore, endoscopic removal via gastrointestinal endoscopy is recommended when BPs are ingested.…”

Section: Introductionmentioning

confidence: 99%

Clinical assessment of computed tomography for detecting ingested blister packs: A single‐center retrospective study

Ishihara,

Ichita,

Jinushi

et al. 2024

DEN Open

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ObjectivesBlister pack (BP) ingestion poses serious risks, such as gastrointestinal perforation, and accurate localization by computed tomography (CT) is a common practice. However, while it has been reported in vitro that CT visibility varies with the material type of BPs, there have been no reports on this variability in clinical settings. In this study, we investigated the CT detection rates of different BPs in clinical settings.MethodsThis single‐center retrospective study from 2010 to 2022 included patients who underwent endoscopic foreign body removal for BP ingestion. The patients were categorized into two groups for BP components, the polypropylene (PP) and the polyvinyl chloride (PVC)/polyvinylidene chloride (PVDC) groups. The primary outcome was the comparison of CT detection rates between the groups. We also evaluated whether the BPs contained tablets and analyzed their locations.ResultsThis study included 61 patients (15 in the PP group and 46 in the PVC/PVDC group). Detection rates were 97.8% for the PVC/PVDC group compared to 53.3% for the PP group, a significant difference (p < 0.01). No cases of BPs composed solely of PP were detected by CT. Blister packs were most commonly found in the upper thoracic esophagus.ConclusionsEven in a clinical setting, the detection rates of PVC and PVDC were higher than that of PP alone. Identifying PP without tablets has proven challenging in clinical. Considering the risk of perforation, these findings suggest that esophagogastroduodenoscopy may be necessary, even if CT detection is negative.

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Undiagnosed Accidental Blister Pack Pill Ingestion in Elderly

Cited by 3 publications

References 8 publications

Unintentional Plastic Blister Ingestion Leading to Intestinal Perforation: A Report of Two Cases

Unintentional Plastic Blister Ingestion Leading to Intestinal Perforation: A Report of Two Cases

The global, regional, and national burden of foreign bodies from 1990 to 2019: a systematic analysis of the global burden of disease study 2019

Clinical assessment of computed tomography for detecting ingested blister packs: A single‐center retrospective study

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