Published online Sep 26, 2018. doi: 10.12998/wjcc.v6.i10.384
Peer-review started: May 16, 2018
First decision: May 24, 2018
Revised: July 26, 2018
Accepted: August 26, 2018
Article in press: August 27, 2018
Published online: September 26, 2018
The accidental ingestion of a foreign body (FB) is a relatively common condition. In the present study, we report a peculiar case of rectal perforation, the first to our knowledge, caused by the inadvertent ingestion of a blister pill pack. The aim of this report is to illustrate the difficulties of the case from a diagnostic and therapeutic viewpoint as well as its unusual presentation. A 75-year-old woman, mentally impaired, arrived at our emergency department in critical condition. The computed tomography scan revealed a substantial abdominopelvic peritoneal effusion and free perigastric air. The patient was therefore submitted to an urgent exploratory laparotomy; a 2-cm long, full-thickness lesion was identified in the anterior distal part of the intraperitoneal rectum. Hence, we performed a Hartmann’s procedure. Because of her critical condition, the patient was eventually transferred to the Intensive Care Unit, where she died after 10 d, showing no surgical complication. The ingestion of FBs is usually treated with observation or endoscopic removal. Less than 1% of FBs are likely to cause an intestinal perforation. The intestinal perforation resulting from the unintentional ingestion of an FB is often a difficult challenge when it comes to treatment, due to its late diagnosis and the patients’ deteriorated clinical condition.
Core tip: Ingestion of a foreign body (FB) is usually treated with observation or endoscopic removal. Less of 1% of FBs can cause an intestinal perforation. Diverticular disease and FB may be associated with pathological processes, including inflammation, perforation, abscess and fistula. The diagnosis of intestinal perforation following the unknown ingestion of a FB is a clinical challenge, first of all because it happens often in patients with intellectual disability or among the psychiatric population and secondly because it is not reported during questioning. Caregivers should be cautious and aware of the cutting of drug blisters.