Press-through-Package Detected by Reconstructed Computed Tomography

Abstract

A 91-year-old woman was evaluated for epigastric discomfort following the unintentional ingestion of a press-through-package (PTP) sheet of two laxative pills. Emergent endoscopy and computed tomography (CT) scan of the esophagus and the stomach failed to detect the sheet because of massive residue in the stomach. Reconstructed imaging of the CT scan clearly revealed the sheet (Figures 1 and 2). Her symptoms subsided on their own without any interventions and she refused repeated endoscopy; she developed no further symptoms. Accidental ingestion of the PTP sheet is common in the elderly [1]. Considering its potential risk for oropharyngeal or gastrointestinal injury, endoscopic removal is the standard management [2]. This imaging suggests that reconstruction of the CT scan has a higher sensitivity than the conventional CT scan and is a promising alternative modality to endoscopy or conventional CT scan, especially when they fail to detect the sheet.