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1
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Wong MF, Ho MP. Comment on life-threatening esophageal perforation due to blister pack ingestion. Am J Emerg Med 2024; 84:186. [PMID: 36737377 DOI: 10.1016/j.ajem.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/22/2023] [Indexed: 01/27/2023] Open
Affiliation(s)
- Mei-Fwa Wong
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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2
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Ino Y, Kitamura M, Nomoto Y, Iwashita C, Miura Y, Yano T, Yamamoto H. A loop cutter is an ideal gripper for endoscopic removal of press-through-package sheets. Endoscopy 2023; 55:E889-E891. [PMID: 37442174 PMCID: PMC10344620 DOI: 10.1055/a-2113-9265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Yuji Ino
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Masafumi Kitamura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshie Nomoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Chihiro Iwashita
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshimasa Miura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Tomonori Yano
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
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3
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Suga T, Oguchi T, Maruyama K. Successful endoscopic mucosal incision and enucleation of an implanted press-through package sheet in the esophageal wall. Dig Endosc 2022; 34:e24-e25. [PMID: 34816487 DOI: 10.1111/den.14184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Tomoaki Suga
- Department of Gastroenterology, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
| | - Takaya Oguchi
- Department of Gastroenterology, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
| | - Kiyotomi Maruyama
- Department of, Surgery, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
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4
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Takasu A, Ikeya T, Fukuda K. Endoscopic Removal of a Press-Through Pack from the Anal Canal. Case Rep Gastroenterol 2021; 15:137-141. [PMID: 33708061 PMCID: PMC7923698 DOI: 10.1159/000511751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
The incidence of press-through pack (PTP) ingestion has been increasing. In many cases, the ingested PTP is lodged in the esophagus. Here, we report a case of endoscopic removal of a PTP from the anal canal. An 89-year-old man with mild dementia presented with a 3-day history of anal pain. On digital rectal examination, we felt a hard and sharp object, which could not be manually removed due to its shape. Therefore, it was removed endoscopically. We inserted an endoscope with a large-caliber soft oblique cap and observed the PTP in the anal canal. It was successfully removed using grasping forceps. The patient was stable, with only mild anal fissures, and no serious complications such as perforation and bleeding were observed. It is generally recognized that a PTP that reaches the large intestine is naturally expelled. Even if a PTP could pass through the pylorus or the small intestine, it could still be difficult to discharge naturally from the anus without discomfort or pain, as in this case.
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Affiliation(s)
- Ayaka Takasu
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
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5
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Wu YH, Ho MP. Comment on secondary peritonitis as a result of accidental ingestion of a press-through package. Geriatr Gerontol Int 2020; 21:278. [PMID: 33336503 DOI: 10.1111/ggi.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yuan-Hui Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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6
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Limpias Kamiya KJL, Hosoe N, Takabayashi K, Hayashi Y, Sun X, Miyanaga R, Fukuhara K, Fukuhara S, Naganuma M, Nakayama A, Kato M, Maehata T, Nakamura R, Ueno K, Sasaki J, Kitagawa Y, Yahagi N, Ogata H, Kanai T. Endoscopic removal of foreign bodies: A retrospective study in Japan. World J Gastrointest Endosc 2020; 12:33-41. [PMID: 31942232 PMCID: PMC6939123 DOI: 10.4253/wjge.v12.i1.33] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/09/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The ingestion of foreign bodies (FBs) and food bolus impaction (FBI) in the digestive tract are commonly encountered clinical problems. Methods to handle such problems continue to evolve offering advantages, such as the avoidance of surgery, reduced cost, improved visualization, reduced morbidity, and high removal success rate. However, to date, no studies have evaluated the endoscopic management of FBs in Japan. AIM To elucidate level of safety and efficacy in the endoscopic management of FBs and FBI. METHODS A total of 215 procedures were performed at Keio University Hospital between November 2007 and August 2018. Data were collected from medical charts, and endoscopic details were collected from an endoscopic reporting system. Procedures performed with a flexible gastrointestinal endoscope were only taken into account. Patients who underwent a technique involving FB or FBI from the digestive tract were only included. Data on patient sex, patient age, outpatient, inpatient, FB type, FB location, procedure time, procedure type, removal device type, success, and technical complications were reviewed and analyzed retrospectively. RESULTS Among the 215 procedures, 136 (63.3%) were performed in old adults (≥ 60 years), 180 (83.7%) procedures were performed in outpatients. The most common type of FBs were press-through-pack (PTP) medications [72 (33.5%) cases], FBI [47 (21.9%)], Anisakis parasite (AP) [41 (19.1%) cases]. Most FBs were located in the esophagus [130 (60.5%) cases] followed by the stomach [68 (31.6%) cases]. AP was commonly found in the stomach [39 (57.4%) cases], and it was removed using biopsy forceps in 97.5% of the cases. The most common FBs according to anatomical location were PTP medications (40%) and dental prostheses (DP) (40%) in the laryngopharynx, PTP (48.5%) in the esophagus, AP (57.4%) in the stomach, DP (37.5%) in the small intestine and video capsule endoscopy device (75%) in the colon. A transparent cap with grasping forceps was the most commonly used device [82 (38.1%) cases]. The success rate of the procedure was 100%, and complication were observed in only one case (0.5%). CONCLUSION Endoscopic management of FBs and FBI in our Hospital is extremely safe and effective.
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Affiliation(s)
- Kenji JL Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Xi Sun
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kayoko Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tadateru Maehata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Koichi Ueno
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
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7
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A Tough Pill to Swallow: Esophageal Perforation After Ingestion of a Blister Pack. ACG Case Rep J 2019; 6:e00152. [PMID: 31737695 PMCID: PMC6791647 DOI: 10.14309/crj.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/31/2019] [Indexed: 12/01/2022] Open
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8
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Tamura T, Okamoto H, Suzuki T, Nakanishi Y, Sugiyama D. Evaluation of the extent of damage to the esophageal wall caused by press-through package ingestion. PeerJ 2019; 7:e6763. [PMID: 31024769 PMCID: PMC6475578 DOI: 10.7717/peerj.6763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/11/2019] [Indexed: 11/22/2022] Open
Abstract
Press-through package (PTP) is the most common accidentally ingested foreign body in Japan. Accidental ingestion of PTP can result in esophageal damage. An approach for evaluating the risk of esophageal injury has not been established. Therefore, we used porcine esophageal tissue and silicone sheets to establish a method for assessing the risk of esophageal damage on accidental PTP ingestion. We pathologically evaluated porcine lower esophageal tissue using a scratch tester. Using porcine esophageal tissue, scratch tests were performed with 4 test objects and pathological damage was compared. It was assumed that each object was accidentally ingested. The objects were polyvinylidene chloride (PVDC)-coated polyvinyl chloride (PVC) PTP, soft PThPa, round PTP, and a disposable scalpel. The porcine esophagus was replaced with a silicon sheet, and an automatic friction machine was used for quantitative evaluation. The silicon sheet was scratched using HHS 2000 with 750-g load at 50 mm/min. We investigated the frictional force exerted on the surface for each of the objects. The degree of damage (depth) was the highest for the disposable scalpel, followed by PVDC-coated PVC PTP, while the degree of damage (depth) was the lowest for soft PThPa and round PTP. The mean frictional forces on the silicon sheet were 524.0 gf with PVDC-coated PTP, 323.5 gf with soft PThPa, 288.7 gf with round PTP, and 922.7 gf with the disposable scalpel. We developed approaches to qualitatively and quantitatively evaluate the risk of esophageal damage after accidental PTP ingestion. Our findings indicate that the risk of gastrointestinal damage after accidental PTP ingestion is low with soft PTP and round PTP.
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Affiliation(s)
- Takuya Tamura
- Department of Research and Development of Next Generation Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Hajime Okamoto
- Research & Development Center, Fujimori Kogyo CO., LTD., Yokohama, Japan
| | - Toyoaki Suzuki
- Research & Development Center, Fujimori Kogyo CO., LTD., Yokohama, Japan
| | - Yoichi Nakanishi
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Daisuke Sugiyama
- Department of Research and Development of Next Generation Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan.,Department of Clinical Study, Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan
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9
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Esophageal impaction caused by a blister-wrapped tablet: Case report and review of the literature. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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10
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Lin LF. Condoms used to assist difficult endoscopic removal of impacted upper esophageal foreign bodies. ADVANCES IN DIGESTIVE MEDICINE 2015. [DOI: 10.1016/j.aidm.2014.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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11
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Takeda M, Yaguchi A, Harada T, Gotoh T, Namiki M. Multidetector computed tomography to detect ingested press-through packages: utility of multiplanar reconstruction imaging in the emergency department. Acute Med Surg 2014; 2:202-206. [PMID: 29123722 DOI: 10.1002/ams2.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/17/2014] [Indexed: 11/06/2022] Open
Abstract
Case We investigated the usefulness of multidetector computed tomography during examination in the emergency department to detect the location of press-through packages that had been inadvertently swallowed. In three patients, four press-through packages were detected on multi-planar reconstruction of multidetector computed tomography images, with three lodged in the esophagus and one in the stomach. Outcome The multidetector computed tomography detection rate of press-through packages was 100% in patients who realized they had swallowed the packages by mistake. After diagnosis, press-through packages in the esophagus were immediately removed endoscopically. Conclusion There are few reports on the usefulness of multi-planar reconstruction images by multidetector computed tomography during examinations in the emergency department for the diagnosis of foreign bodies in patients who have mistakenly swallowed press-through packages. Detecting the location of the packages provided useful information regarding the strategy for their removal. Therefore, proactive multidetector computed tomography use in the emergency department could be beneficial for patients who have inadvertently swallowed press-through packages.
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Affiliation(s)
- Munekazu Takeda
- Department of Critical Care and Emergency Medicine Tokyo Women's Medical University Tokyo Japan
| | - Arino Yaguchi
- Department of Critical Care and Emergency Medicine Tokyo Women's Medical University Tokyo Japan
| | - Tomoyuki Harada
- Department of Critical Care and Emergency Medicine Tokyo Women's Medical University Tokyo Japan
| | - Taijirou Gotoh
- Department of Critical Care and Emergency Medicine Tokyo Women's Medical University Tokyo Japan
| | - Mizuho Namiki
- Department of Critical Care and Emergency Medicine Tokyo Women's Medical University Tokyo Japan
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12
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Kanazawa A, Kamezaki F, Kido T, Yamasaki S, Someya K, Takama T, Otsubo H, Yoshikawa I, Kamochi M, Mayumi T. Press-through package mis-swallowing: Usefulness of computed tomography. Acute Med Surg 2014; 2:195-198. [PMID: 29123720 DOI: 10.1002/ams2.90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/08/2014] [Indexed: 11/05/2022] Open
Abstract
Case An 88-year-old female with Alzheimer's-type dementia who mis-swallowed a press-through package visited our emergency department. Outcome Plain radiography detected no foreign bodies, whereas plain computed tomography showed an elliptical body with a high density in the lower esophagus. The press-through package containing a tablet in the esophagogastric junction was successfully removed without severe complications using the endoscopic protector hood. In cases of press-through package mis-swallowing, it is important for emergency physicians to make an early and correct diagnosis of the location of the package, which shows high radiolucency. Based on the results of this case, we hypothesize that carrying out early computed tomography examinations is useful for identifying swallowed press-through packages. Our retrospective investigation showed that computed tomography has a sensitivity of 100% for detecting press-through packages. Conclusion We experienced a case of press-through package mis-swallowing diagnosed on computed tomography. We recommend performing computed tomography examinations, especially in patients with an uncertain history and unclear symptoms.
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Affiliation(s)
- Ayako Kanazawa
- Department of Emergency Medicine University of Occupational and Environmental Health Kitakyushu Japan.,Intensive Care Unit University of Occupational and Environmental Health Hospital Kitakyushu Japan
| | - Fumihiko Kamezaki
- Department of Emergency Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Takashi Kido
- Department of Emergency Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Seigen Yamasaki
- Department of Emergency Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Kazuki Someya
- Department of Emergency Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Tatsuo Takama
- Department of Emergency Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Hiroki Otsubo
- Department of Emergency Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Ichiro Yoshikawa
- Endoscopy Unit University of Occupational and Environmental Health Hospital Kitakyushu Japan
| | - Masayuki Kamochi
- Intensive Care Unit University of Occupational and Environmental Health Hospital Kitakyushu Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine University of Occupational and Environmental Health Kitakyushu Japan
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13
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Ho MP, Tsai KC, Chang WH. Gastric ulcer bleeding caused by press-through package mis-swallowing. J Am Geriatr Soc 2012; 60:1366-7. [PMID: 22788393 DOI: 10.1111/j.1532-5415.2012.04014.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Domen H, Ohara M, Noguchi M, Nakanishi Y, Komuro K, Iwashiro N, Ishizaka M. Inadvertent Ingestion of a Press-Through Package Causing Perforation of the Small Intestine within an Incisional Hernia and Panperitonitis. Case Rep Gastroenterol 2011; 5:391-5. [PMID: 21792348 PMCID: PMC3142101 DOI: 10.1159/000330290] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A 90-year-old woman was admitted to the emergency department of our hospital with abdominal pain and a fever of up to 39°C. She had a history of hysterectomy about 30 years previously, and redness and swelling were seen at the abdominal median scar. Serum biochemistry showed minor elevation of C-reactive protein and creatine phosphokinase. Abdominal computed tomography (CT) showed an edematous intestinal tract image over the median abdominal wall. Incarcerated incisional hernia and intestinal necrosis were suspected. Therefore, emergency surgery was performed. On laparotomy, abundant purulent ascitic fluid was found. The small intestine was incarcerated about 100 cm orally from the terminal ileum, and a 2-mm perforation was present in the incarcerated small intestine. In addition, some white areas measuring 1 mm were found in the small intestinal wall. A press-through package (PTP) of a tablet was confirmed in the intestinal tract near the perforated area. We removed the PTP through the perforation and performed direct suture. Postoperatively, we retrospectively reviewed the CT image and found a high-density shadow which seemed to represent the PTP.
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Affiliation(s)
- Hiromitsu Domen
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
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15
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Images in emergency medicine. Press-through package mis-swallowing. Ann Emerg Med 2008; 52:98, 115. [PMID: 18655920 DOI: 10.1016/j.annemergmed.2007.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 10/30/2007] [Accepted: 11/05/2007] [Indexed: 11/27/2022]
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16
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Tai AW, Sodickson A. Foreign body ingestion of blister pill pack causing small bowel obstruction. Emerg Radiol 2007; 14:105-8. [PMID: 17342467 DOI: 10.1007/s10140-007-0582-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 01/16/2007] [Indexed: 02/07/2023]
Abstract
We report a case of foreign body ingestion of a blister pill pack, causing small bowel obstruction. A 76-year-old woman on multiple medications presented with 3 days of progressive abdominal distention, nausea, and vomiting. A computed tomography (CT) scan demonstrated small bowel obstruction with a distinctive metallic foreign body in the distal ileum with associated wall thickening and mesenteric inflammatory changes. At exploratory laparotomy, an impacted, intact blister pill pack was removed from the distal ileum. The ingestion of blister pill packs has been associated with a range of clinical and imaging findings. To our knowledge, this is the only reported case of CT diagnosis of small bowel obstruction caused by blister pack ingestion. Early recognition of the imaging findings of an ingested blister pill pack is important to expedite appropriate management.
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Affiliation(s)
- Angela W Tai
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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17
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Seo YS, Park JJ, Kim JH, Kim JY, Yeon JE, Kim JS, Byun KS, Bak YT. Removal of press-through-packs impacted in the upper esophagus using an overtube. World J Gastroenterol 2006; 12:5909-12. [PMID: 17007065 PMCID: PMC4100680 DOI: 10.3748/wjg.v12.i36.5909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Foreign bodies in the upper esophagus should be removed as soon as possible to avoid serious complications. However, removals of foreign bodies in the upper esophagus are very difficult, especially if they have sharp edges, such as press-through-packs (PTPs). We experienced four cases of the impacted PTPs in the upper esophagus which was successfully extracted endoscopically with the overtube. Because two edges of PTPs were so firmly impacted in the esophageal wall in all cases, the PTPs were not movable in the upper esophagus. However, after insertion of the overtube, PTPs became movable and were successfully extracted and no serious complications occurred after extraction of PTPs. In one case, insertion of the overtube rapidly expanded the upper esophagus and PTP progressed to the gastric cavity and it could be extracted with the endoscopic protector hood. The endoscopic removal with the overtube was a simple, safe and effective technique for the removal of the impacted PTPs in upper esophagus.
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Affiliation(s)
- Yeon-Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Gurodong-gil 97, Guro-gu, Seoul, Korea
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18
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Abstract
A press through package (PTP) is commonly used as a package for drugs and also being seen increasingly in cases of foreign body in the digestive tract. We presented three cases of inadvertent PTP ingestion with a variety of clinical presentations. Although commonly considered to be small and soft to cause bowel damage, a PTP tends to be caught and poses potential risk for perforation of the bowel because of its sharp edges. The PTP material is thought to be difficult to detect on plain abdominal roentgenography due to its radiolucency. However, air trapped in the PTP makes the drug tablet possibly visible on the radiograph. All of the three cases were diagnosed with correct interpretation of these special radiographic findings, even without the recall of accidental swallowing of the tablet. A PTP in the oesophagus and stomach should be tried to be removed, while computerised tomography and early laparotomy should be considered when it passes through the pyloric ring and the patient develops symptoms. An effort to prevent the PTP swallowing should be an essential part in our everyday practice, especially for the elderly patients.
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Affiliation(s)
- Sen-Kuang Hou
- Emergency Department,Taipei Veterans General Hospital, Institute of Emergency and Critical Care Medicine, Taiwan, ROC
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