Foreign body ingestion is a common occurrence in vulnerable populations, predominantly at the ends of the age spectrum. While most cases are uncomplicated, some patients may require endoscopic or surgical intervention to prevent serious complications. Therefore, accurate and detailed radiological evaluation is essential for therapeutic decision-making. We present the case of an 80-year-old woman presenting with abdominal pain and radiological evidence of a foreign body in the small intestine. A conservative treatment approach was initially proposed due to the absence of complications and the hypothesis that a fishbone was the cause. However, her condition deteriorated due to bowel injury, complicated by bleeding and perforation. Multiplanar and 3D reconstructions identified the object as a medication blister located in the sigmoid colon. Urgent surgical intervention allowed for the retrieval of the object and the closure of the bowel perforation. This case highlights the importance of early, detailed, and accurate radiological evaluation to identify the characteristics of foreign bodies and guide timely intervention.