A folded-blister pill pack causes ileal perforation.

Ileal perforation by an accidental ingestion of a blister pill pack is rare. A detailed history of the present illness is the initial key to proceed appropriate investigations. Computed tomography is the gold standard for diagnosis of the disease.

Inadvertent ingestion of a blister pack is a rare cause of ileal perforation. Since a blister pack is typically radiolucent, laparotomy remains a diagnostic and therapeutic procedure to identify the cause of perforation. Computed tomography may be a promising tool to detect a blister pack in the bowels.

QUESTION

An 85‐year‐old Japanese woman was presented to our hospital with colicky abdominal pain, nausea, and vomiting of 1‐day period. She had a high fever, and laboratory test revealed leukocytosis with inflammatory reaction. Abdominal contrast‐enhanced computed tomography (CT) was performed to detect the primary cause of her symptoms (Figure 1). What is the diagnosis?

Figure 1

Abdominal contrast‐enhanced computed tomography (A: axial; B: coronal plane) showed two pairs of stacked high‐density bricks (arrow), which represented a folded‐blister pill pack containing 4 tablets of loxoprofen, in a poorly enhanced ileal lesion. Peritoneal free gases (arrowheads) and para‐ileal effusions suggested acute peritonitis by the ileal perforation

ANSWER

Ileal perforation by inadvertent ingestion of a blister pack

CT revealed a part of poorly enhanced ileal lesion containing two pairs of stacked high‐density bricks (Figure 1A, arrow). Free gases and fluids within a peritoneal cavity suggested an intestinal perforation (Figure 1, arrowheads). She was transported to another hospital, and an emergency laparotomy was performed. Approximately 30 cm of small intestine was resected, and a folded‐blister pill pack containing 4 tablets of loxoprofen was found. A whole part of the package was 40 × 15 × 8 mm.

Inadvertent ingestion of a blister pack is a rare cause of bowel perforation in <1% of the accidental ingestion of a foreign body.1 Among the sites of perforation, the ileum accounts for approximately two thirds of all intestinal perforations by a blister pack.2 Although a blister pack is typically radiolucent, CT is a promising tool to detect the ingested pack. In addition, a detailed history of the present illness is a key to proceed appropriate radiological investigation.

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare regarding this manuscript.

AUTHOR CONTRIBUTIONS

YO, NY, and YY: drafted the manuscript, obtained the pictures, and contributed to patient care. JT and TT: supervised the study and critically reviewed the paper. All authors wrote, proofread, and approved the manuscript.