Multidetector computed tomography to detect ingested press‐through packages: utility of multiplanar reconstruction imaging in the emergency department

Abstract

Case:We investigated the usefulness of multidetector computed tomography during examination in the emergency department to detect the location of press-through packages that had been inadvertently swallowed. In three patients, four press-through packages were detected on multi-planar reconstruction of multidetector computed tomography images, with three lodged in the esophagus and one in the stomach.Outcome: The multidetector computed tomography detection rate of press-through packages was 100% in patients who realized they had swallowed the packages by mistake. After diagnosis, press-through packages in the esophagus were immediately removed endoscopically. Conclusion:There are few reports on the usefulness of multi-planar reconstruction images by multidetector computed tomography during examinations in the emergency department for the diagnosis of foreign bodies in patients who have mistakenly swallowed press-through packages. Detecting the location of the packages provided useful information regarding the strategy for their removal. Therefore, proactive multidetector computed tomography use in the emergency department could be beneficial for patients who have inadvertently swallowed press-through packages.

Non-traumatic adult acute abdomen with high-attenuation lesions or materials in the gastrointestinal tract on unenhanced computed tomography

“…[ 11 ] Because of their sharp corners, ingested PTPs represent a potential risk for gastrointestinal bleeding, mediastinitis, intestinal perforation, and obstruction. [ 11 ] PTPs show characteristic findings on CT – that is, high-attenuation oval-shaped materials representing the tablet with surrounding air bubbles in the plastic dome and a linear high-attenuation material on the base representing the sheet[ 11 12 ] [ Figure 10 ]. If only the aluminium sheet is ingested, it may present as a linear high-attenuation material and mimic a fish bone [ Figure 11 ].…”

Secondary peritonitis as a result of accidental ingestion of a press‐through package

“…2 However, an aluminum sheet could be identified as a high-density linear shadow. 3 In this case, we retrospectively reviewed the X-ray and could identify the PTP, including the tablet at the hepatic flexure (Fig. 1a).…”

“…1 In the Netherlands and many other countries, it is common practice to discuss do-not-resuscitate (DNR) decisions. [2][3][4] As such, frail older individuals often have a DNR order, while still frequently undergoing surgery near the end of life. 5,6 A commonly held perception is that resuscitation in the operating room (OR) is more successful than out-of-hospital settings and therefore a waiver of pre-existing DNRs should be considered.…”