Multiple intestinal perforations due to blister pill pack ingestion

Foreign body ingestion-related peritonitis in an elderly peritoneal dialysis patient

Among peritoneal dialysis patients, peritoneal dialysis-related peritonitis is a well-known complication, but it can also be non-peritoneal dialysis-related (e.g. ruptured appendix). Ileal perforation by foreign bodies such as blister pill packs can be seen in the emergency room. Differentiating this from peritoneal dialysis-related peritonitis can be difficult, since they can have both identical presentations. Computed tomography can be of value in detecting abscess, thickening of the digestive wall or adhesions, and exclude other causes of intra-abdominal sepsis. Because of the aging population, ingestion of foreign body can be expected to rise. We therefore recommend that blister pill packs should not be divided into single-dose pieces, and we invite elderly patient’s entourage to check medication administration. Furthermore, manufacturing efforts are highly recommended to improve blister pill pack’s design, to avoid accidental ingestion. We report the case of an elderly peritoneal dialysis patient who presented with peritonitis due to ileal perforation because of blister pill pack ingestion.

Aspiration of a drug in a blister pack

We report a rare case of aspiration of a drug in a press-through package (PTP) treated by not just pulling it but using a unique technique. A 73-year-old woman was referred to our department because of a persistent cough resulting from aspiration of a PTP. Flexible bronchoscopy identified the PTP in the trachea immediately above the carina. Just pulling the centre of the PTP edge with biopsy forceps could not move it, and we then rotated it by pulling the corner of the PTP edge to directly below the vocal cord. Passing over the vocal cord was difficult, which made us remove the bronchoscope and urge the patient to cough. These rotation techniques and voluntary coughing successfully removed the foreign body. This unique procedure may aid in the removal of a similar foreign body using a flexible bronchoscope forceps with insufficient grasping force.