A case of small bowel perforation caused by a swallowed press-through package, during the course of infliximab treatment

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  • HAYASHI Tatsuya
    Department of Gastrointestinal Surgery, Kyoundo Hospital annexed to the Sasaki institute
  • KAWAMOTO Jun
    Department of Gastrointestinal Surgery, Kyoundo Hospital annexed to the Sasaki institute
  • MIURA Seiki
    Department of Gastrointestinal Surgery, Kyoundo Hospital annexed to the Sasaki institute

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Other Title
  • インフリキシマブ治療中のpress through package誤飲による小腸穿孔の1例
  • 症例 インフリキシマブ治療中のpress through package誤飲による小腸穿孔の1例
  • ショウレイ インフリキシマブ チリョウ チュウ ノ press through package ゴイン ニ ヨル ショウチョウ センコウ ノ 1レイ

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Abstract

The patient was an 83-year-old woman who had accidentally ingested a press-through package (PTP) and was referred to our hospital for lower abdominal pain 3 days after PTP ingestion. She was being treated with anti-TNF-α antibody (infliximab) for rheumatoid arthritis. The day after the accidental PTP ingestion, she was administered infliximab. Two days later, she was treated with methotrexate. An abdominal CT scan showed the PTP in the ileum and ascites around the intestine. The blood test detected an increase in the inflammatory response. A diagnosis of acute pan-peritonitis was made, and emergency laparotomy was performed. There was a moderate amount of turbid ascites, and the PTP was palpable in the ileum. A white moss-like layer had adhered to the ileum, and therefore microperforation was considered. Partial ileum resection and peritoneal lavage were performed. Postoperative complications such as infection were not observed. We report this case with a review of the literature regarding perioperative management during the administration of infliximab and for accidental ingestion of PTP.

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