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. 2015:14:129-32.
doi: 10.1016/j.ijscr.2015.07.013. Epub 2015 Jul 28.

An unusual case of duodenal perforation caused by a blister pack: A case report and literature review

Si-Yuan Yao  1 , Yugo Matsui  2 , Souichi Shiotsu  3
Affiliations

An unusual case of duodenal perforation caused by a blister pack: A case report and literature review

Si-Yuan Yao et al. Int J Surg Case Rep. 2015.

Abstract

Introduction: Ingestion of foreign bodies is a relatively common clinical problem. Blister packs have been known to be a causative agent of gastrointestinal perforation. We report a rare case of duodenal perforation caused by a blister pack, which was complicated by retroperitoneal abscess and having a poor outcome.

Presentation of case: A 72 year-old man with a history of dementia presented to the emergency department with a 2-day history of backache. Upon radiological findings, perforated peptic ulcer was suspected. However, emergency laparotomy revealed a blister pack protruding from the posterior wall of the third portion of the duodenum. It was complicated by a widespread retroperitoneal abscess. After removal of the foreign body, the perforation was treated with primary suture repair and an omental patch. However, the patient died two days after operation due to sepsis.

Discussion: According to a literature review, the ileum is the most common site of perforation caused by blister packs. To our knowledge, duodenal perforations have not been documented to date. Curative treatment often involves emergent surgery. However, duodenal perforation in the third portion may lead to retroperitoneal abscess, which can result in severe sepsis and have a poor outcome. As there is no consensus about an ideal surgical approach, retroperitoneal abscess is one of the clinical challenges for surgeons. Even with prompt management, duodenal perforation may become fatal.

Conclusion: Unnoticed ingestion of blister packs can cause duodenal perforation. Although prompt management is necessary, duodenal perforation, especially in the third portion, may be potentially fatal.

Keywords: Blister pack; Duodenal perforation; Foreign body; Retroperitoneum abscess.

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Figures

Fig. 1
Fig. 1
Preoperative radiological findings. (A) Radiography showed free free intraperitoneal air under the right diaphragm. (B) CT revealed widespread pneumoretroperitoneum (arrow heads).
Fig. 2
Fig. 2
Intraoperative findings. (A) A perforation was detected at the posterior wall of the third portion of duodenum. (B) A 25 mm × 15 mm blister pack was protruding from the lumen. (C) After foreign body removal, 3-cm laceration was obserbed. (D) Primary suture repair was performed, followed by mental patch and peritoneal lavage.
Fig. 3
Fig. 3
Review of preoperative CT. A dense linear opacity could be recognized in the axial and coronal plane (arrow).
See this image and copyright information in PMC

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