An Unusual Cause of Odynophagia - “The Blister Pack”

Abstract

Purpose: Accidental or purposeful ingestion of foreign bodies, especially blister packing, in adults is most frequently encountered at the extremes of age and among individuals who are mentally or visually impaired. We present a rare case of odynophagia and esophageal ulceration in a mentally competent adult secondary to blister packing ingestion. Case Report: A 30 year computer engineer was admitted to the hospital with increasing pain on swallowing for the past 12 hours. Pain was sudden in onset and not relieved with any medications. Pain described as sharp, 10/10 in his chest, worsened with swallowing. He was apparently suffering from upper respiratory infection and had been taking multiple over the counter (OTC) medications, including antihistamines. He experienced this pain when he took some of his medications last night while in bed. In the ER, the patient appeared very anxious and tearful and complained of excruciating pain in the chest. Vitals were significant for tachycardia and hypertension. Chest X ray showed translucent rectangular object in the upper esophagus. There was no evidence of perforation. An urgent endoscopy was performed at the bedside which showed an aluminum blister pack containing 4 acetaminophen and caffeine tablets wedged in the upper esophagus. The blister pack was found to have eroded into the esophageal mucosa without apparent perforation. After a technically difficult procedure, the foreign body was eventually removed successfully with a rat tooth forcep. Esophageal mucosal injury was significant for deep vertical ulcers. There was no evidence of perforation. The patient was managed conservatively with proton pump inhibitors and oral antibiotics and discharged the next day. Conclusion: This case illustrates that inadvertent ingestion of blister packs must be considered in the differential even in young competent adults.Figure: Blister pack in the upper esophagus.