Fleres F, Ieni A, Saladino E, Speciale G, Aspromonte M, Cannaò A, Macrì A. Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature. World J Clin Cases 2018; 6(10): 384-392 [PMID: 30283801 DOI: 10.12998/wjcc.v6.i10.384]
Corresponding Author of This Article
Francesco Fleres, MD, Doctor, Medical Assistant, Surgeon, Department of Youth and Adulthood Human Pathology “Gaetano Barresi”, General Surgery Unit, University of Messina, Via Consolare Valeria, Messina 98125, Italy. franz.fleres@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 26, 2018; 6(10): 384-392 Published online Sep 26, 2018. doi: 10.12998/wjcc.v6.i10.384
Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature
Francesco Fleres, Antonio Ieni, Edoardo Saladino, Giuseppe Speciale, Michele Aspromonte, Antonio Cannaò, Antonio Macrì
Francesco Fleres, Michele Aspromonte, Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina, Messina 98125, Italy
Antonio Ieni, Giuseppe Speciale, Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of Anatomic Pathology, University of Messina, Messina 98125, Italy
Edoardo Saladino, General and Oncologic Surgery Unit, Clinica Cappellani-GIOMI, Messina 98168, Italy
Antonio Cannaò, Messina University Medical School Hospital, Messina 98125, Italy
Antonio Macrì, Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, Messina University Medical School Hospital, Messina 98125, Italy
Author contributions: Fleres F, Saladino E, Aspromonte M and Macrì A participated in the conception and design of the report; Fleres F and Macrì A drafted the paper and analyzed the report; Macrì A performed the surgical procedure; Macrì A was involved in the diagnosis, surgical management and follow-up of the patient; Cannaò A was involved in the patient’s surgical management; Ieni A and Speciale G carried out the histological procedures.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Informed consent statement: Written informed consent was obtained from the patient ahead of the publication of this Case Report and its accompanying images. A copy of the written informed consent is available for review by the Editor-in-Chief of this journal.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Francesco Fleres, MD, Doctor, Medical Assistant, Surgeon, Department of Youth and Adulthood Human Pathology “Gaetano Barresi”, General Surgery Unit, University of Messina, Via Consolare Valeria, Messina 98125, Italy. franz.fleres@gmail.com
Telephone: +39-090-2212678 Fax: +39-090-2213524
Received: May 16, 2018 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 Processing time: 133 Days and 15.4 Hours
Abstract
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.
