A Case of Ileal Perforation Caused by Inadvertent Ingestion of a Press-Through Package Detected on CT Examination

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  • 腹部CTにより診断可能と考えられたpress-through package誤飲による回腸穿孔の1例

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Abstract

An 86-year-old woman visited another hospital complaining of nausea and diarrhea. Following intravenous hydration these symptoms improved, but after seven days she developed abdominal pain and was brought to our hospital. On palpation there was muscle guarding with tenderness in the lower abdomen. A computed tomography scan (CT) of the abdomen showed some ascites and enlarged small intestine with fluid retention in the peritoneal cavity. An emergency laparotomy was performed because of acute abdomen. A 3 mm perforation at the antimesenteric border of the ileum, 50 cm proximal to the ileocecal valve, was found on laparotomy and a press-through package (PTP) containing a tablet was discovered in this region. The patient′s condition was diagnosed as perforation of the ileum by inadvertent ingestion of a PTP; the perforated section was closed with sutures. When the preoperative abdominal radiograph and CT were reviewed after surgery, a PTP-shaped opacity was noted. The patient had no memory of accidentally swallowing the PTP and, according to her family, she showed no evidence of behavior disturbances. Subsequently, PTPs divided into single tablets were found in her home.

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