title: [Bowel perforation because of ingestion of a blister-wrapped tablet  after post-interventional coronary perforation].
abstract: METHODS
  A 70-year-old woman was admitted to hospital with progressive chest pain. Coronary angiography demonstrated a significant stenosis of the left descending artery (LAD), which was treated by percutaneous coronary intervention (PCI) and stent implantation. During this intervention, a coronary perforation occurred which was remedied immediately. Five days after the intervention, the patient complained about severe atypical chest and abdominal pain with nausea and vomitting, but no fever. Physical examination revealed an acute abdomen of uncertain origin.
  
  
  METHODS
  Laboratory tests revealed leukocytosis and elevated levels of C-reactive protein while cardiac enzymes were in normal range. The electrocardiogram showed no signs of acute myocardial ischemia. Abdominal x-ray was performed without any pathological findings. Further diagnostic tests, especially computed tomography of the abdomen, revealed an ingestion of a blister-wrapped tablet which had caused small bowel perforation and peritonitis.
  
  
  METHODS
  An acute abdomen due to ingestion of a foreign body was diagnosed and an emergency laparotomy was performed immediately. The blister pack was removed by ileostomy. The further course was uneventful.
  
  
  CONCLUSIONS
  The clinical presentation of abdominal pain is a frequent medical condition in hospital. Determining the cause requires precise assessment and examination and implicates a variety of differential diagnosis including non-cardiac and cardiac pain. Iatrogenic causes must be considered in differential diagnosis.
authors.affiliation: Medizinische Klinik II (Kardiologie und Angiologie), Universitätsklinik Marienhospital Herne, Klinikum der Ruhr-Universität Bochum. benjamin-michel.sasko@marienhospital-herne.de
authors.forename: B
authors.initials: B
authors.lastname: Sasko
authors.forename: T
authors.initials: T
authors.lastname: Butz
authors.forename: G
authors.initials: G
authors.lastname: Winnekendonk
authors.forename: G
authors.initials: G
authors.lastname: Plehn
authors.forename: M
authors.initials: M
authors.lastname: Prull
authors.forename: D
authors.initials: D
authors.lastname: Liermann
authors.forename: H-J
authors.initials: HJ
authors.lastname: Trappe
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D000319:Adrenergic beta-Antagonists; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries*; D004349:Drug Packaging; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007081:Ileostomy; D007082:Ileum / Q000000981:diagnostic imaging / Q000293:injuries*; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008790:Metoprolol / Q000031:analogs & derivatives*; D061330:Multidetector Computed Tomography; D010538:Peritonitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D015607:Stents; D013607:Tablets
chemical_list: D000319:Adrenergic beta-Antagonists; D013607:Tablets; D008790:Metoprolol