Rico Ferdinand, Sbar Alan, Lung John
Department of Surgery, Division of Trauma, Acute Care Surgery, Surgical Critical Care and General Surgery, Mohawk Valley Health System - St. Elizabeth's Hospital, Utica, USA.
Department of Specialty Medicine, University of New England, College of Osteopathic Medicine, Biddeford, USA.
Cureus. 2022 Apr 6;14(4):e23895. doi: 10.7759/cureus.23895. eCollection 2022 Apr.
We present a case of accidental ingestion of a foreign body-blister pill pack (FB-BPP) causing small bowel perforation in a patient taking aspirin and clopidogrel due to past history of coronary artery disease. A 71-year-old male presented in the emergency department (ED) with a two-day history of abdominal discomfort and loss of consciousness. His relevant home medication included aspirin and clopidogrel secondary to a history of coronary artery stents. Initial workup with emergent CT scan of abdomen/pelvis with intravenous contrast showed a loop of the terminal ileum with thickened wall and perforation. Incidentally, he was also found to have type II myocardial infarction. Emergent laparoscopic ileocecectomy with primary anastomosis was done. The postoperative course was unremarkable. The pathology report of the small bowel was consistent with a FB-BPP associated perforation. FB-BPP ingestion with perforation is a rare occurrence. It occurs more often in the elderly with significant mortality. Our case of accidental ingestion of FB-BPP was confirmed retrospectively after histopathological evaluation, and complicated by type II myocardial infarction. Emergent laparoscopic bowel resection was done despite significant preoperative risks.
我们报告一例因意外摄入异物泡罩包装药丸（FB-BPP）导致小肠穿孔的病例，患者因既往有冠状动脉疾病史而正在服用阿司匹林和氯吡格雷。一名71岁男性因腹部不适和意识丧失两天就诊于急诊科（ED）。他在家中服用的相关药物包括因冠状动脉支架置入史而服用的阿司匹林和氯吡格雷。腹部/盆腔增强CT扫描的初步检查显示末端回肠肠袢肠壁增厚并穿孔。偶然发现，他还患有II型心肌梗死。急诊行腹腔镜回盲部切除术并一期吻合。术后过程顺利。小肠病理报告与FB-BPP相关穿孔一致。FB-BPP摄入伴穿孔是一种罕见情况。它更常发生在老年人中，死亡率较高。我们这例FB-BPP意外摄入病例经组织病理学评估后得以确诊，并伴有II型心肌梗死。尽管术前风险很大，仍急诊行腹腔镜肠切除术。
