Correspondence

Stomach Perforation by a Blister-Wrapped Capsule

N Engl J Med 1996; 335:754-755September 5, 1996

Article

To the Editor:

We describe a 63-year-old woman whose stomach was perforated after she ingested a blister-wrapped capsule while hospitalized for treatment of depression. She was treated with oral lormetazepam (Noctamid), paroxetine (Deroxat), buspirone (Buspar), and cyamemazine (Tercian) and with ranitidine (Azantac) for a previous duodenal ulcer. On the third hospital day she had vomiting, headache, and abdominal pain. She was afebrile. Hypertension (blood pressure, 250/120 mm Hg) and mild tachycardia (100 beats per minute) were detected. She was admitted to a cardiology service. Nifedipine (Adalate) was prescribed to treat the hypertension.

The next day, she fainted twice in one hour and was hypotensive and diaphoretic. No explanation of the symptoms was found with echocardiography and esophagogastroduodenoscopy. Her hemodynamic and renal function deteriorated, and her abdominal pain became more acute. An abdominal computed tomographic scan revealed a perihepatic hematoma, a splenic wound, and a hemoperitoneum.

On laparotomy, the coronary artery of the stomach was found to be injured and the lesser gastric curvature perforated by the sharp edge of a blister-wrapped capsule of acetaminophen (paracetamol [Dafalgan]). An inquiry revealed that on the psychiatric ward, the patient had had a prescription for acetaminophen “as needed” for toothache. A capsule still wrapped in a blister had been left for her use, because she showed no symptoms of confusion or disorientation and her depression was stable.

Cases have been reported of esophageal impaction with blister-wrapped medicines1 and of intestinal perforation by plastic and aluminum foil used in blister wrapping.2 Obviously, ingesting a blister-wrapped tablet without removing the wrapping is dangerous. The potential risk to a hospitalized patient can be eliminated if a nurse removes the wrapping.

Agnès Lurton, Pharm.D.
Jean Ntiruhungwa, M.D.
Huguette Saillant, M.D.
Jacqueline Surugue, Pharm.D.
Centre Hospitalier Spécialisé de la Sarthe, 72700 Allonnes, France

2 References

1. 1

   Bour B, Blanchi A. Déconditionner les médicaments: une nécessité chez les personnes âgées: 3 cas d'impaction œsophagienne. Presse Med 1993;22:131-131
   Web of Science | Medline

2. 2

   Norstein J, Krajci P, Bergan A, Geiran O. Intestinal perforation after ingestion of a blister-wrapped tablet. Lancet 1995;346:1308-1308
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Joaquín Campos Franco, Raimundo López Rodríguez, Anxo Martínez De Alegría, Cristina Dios Loureiro, Rosario Alende Sixto, Arturo González Quintela. (2011) Perforación esofágica tras ingestión de un comprimido en blíster. Gastroenterología y Hepatología 34:7, 515-516
   CrossRef