A case of transcutaneous drainage and percutaneous transluminal treatment for perforation of the small intestine caused by pressure caused by accidental package ingestion in a patient with a history of bypass surgery for radiation intestinal stenosis

A 71-year-old woman underwent extended total hysterectomy and adjuvant pelvic irradiation in 1999. Then she suffered several bowel obstructions and finally she underwent ileo-transverse colon bypass surgery in 2009. She visited our hospital because of right inguinal pain in 2014. CT revealed pelvic abscess due to intestinal perforation caused by mistaken swallowing of a press-through package (PTP). Surgery was not easily applied to remove the PTP owing to previous pelvic irradiation. Colonoscopy seemed difficult to remove it partly because of its location 50 cm far from terminal ileum. At first, extracorporeal drainage was done. After the completion of the drainage route, the PTP was successfully removed with endoscopy via this drainage route. Surprisingly this drainage route did not close after the removal of the drainage tube because of dysfunction of the ileo-transverse colon bypass. Finally this bypass was repaired by dividing the oral side ileum of the bypass to make it a complete bypass, then the anal side of this division was diverted as an ileostomy to the abdominal wall. The postoperative course was uneventful and she was discharged on the 20th postoperative day.