Wright State University Boonshoft School of Medicine Centerville, OH
Introduction: Perforation of the small bowel resulting in resection due to foreign body ingestion occurs in less than 1% of all foreign body ingestions (FBI). Commonly FBI occurs in children and the elderly, due to shared risk factors including age and poor cognitive function. The main purpose of blister pill packs is to prevent tampering and most importantly seal individual tablets for protection and safety against ultraviolet light. Here we describe accidental ingestion of a blister pill pack presenting as abdominal pain, resulting in a small bowel resection.
Case Description/Methods: An 86-year-old female presented with a chief complaint of abdominal pain. She rated the pain at an 8 out of 10. She noted that movement made the pain worse, and no activity made it better. She denied any hematochezia, melena, diarrhea, or constipation.
Initial diagnostic workup for abdominal pain included computed tomography (CT) of the Abdomen and Pelvis. CT scan revealed a partial small bowel obstruction with dilated, fecalized small bowel proximal to the blister pack and non-distended small bowel distally [Image 1a]. Subsequently, the patient was taken to the operating room, where the blister pack was turned 180 degrees and found to be adherent to the right lower quadrant of the small bowel [Image 1b]. Small bowel resection was completed successfully with anastomosis of the bowel. Patient had resumed diet with resumption of bowel movements within 10 days post-operation.
Discussion: Foreign body ingestion is a common occurrence in children and elderly people. Most locations of impaction include the stomach and esophagus. Rare effects of blister pack ingestion may include small bowel obstruction leading to perforation as seen in our case. Clinicians should be aware of a broad differential when considering ingestion of an unknown substance, including small bowel obstruction, perforation, or aspiration.
