Among peritoneal dialysis patients, peritoneal dialysis-related peritonitis is a well-known complication, but it can also be non-peritoneal dialysis-related (e.g. ruptured appendix). Ileal perforation by foreign bodies such as blister pill packs can be seen in the emergency room. Differentiating this from peritoneal dialysis-related peritonitis can be difficult, since they can have both identical presentations. Computed tomography can be of value in detecting abscess, thickening of the digestive wall or adhesions, and exclude other causes of intra-abdominal sepsis. Because of the aging population, ingestion of foreign body can be expected to rise. We therefore recommend that blister pill packs should not be divided into single-dose pieces, and we invite elderly patient's entourage to check medication administration. Furthermore, manufacturing efforts are highly recommended to improve blister pill pack's design, to avoid accidental ingestion. We report the case of an elderly peritoneal dialysis patient who presented with peritonitis due to ileal perforation because of blister pill pack ingestion.