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

Abstract

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 nonspecific 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 REPORT 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.

Figure 1.

(A) Chest/abdomen CT, initially described as unremarkable. (B) Chest/abdomen CT on the following day. Short wall thickening of the small intestine and intraluminal small hyperdense structure of 2 cm length was retrospectively already visible on the previous day (arrows). CT – computed tomography.

Figure 2.

(A) Perforation site of the small intestine (arrow). (B) Empty, sharp-edged blister.

Figure 3.

(A) Small, elongated, unidentified foreign body in the stomach (arrow). (B) Elongated, unidentified foreign body in the esophagus.

Figure 4.

(A) Empty medication blister in the esophagus. (B) Empty medication blister in the stomach corpus.