A very unfortunate Florida man was having breakfast in a diner when a sneeze caused his guts to pop out of his body.
The 63-year-old man, who had recently had abdominal surgery, found himself eviscerated after sneezing and coughing, with several loops of his large intestine flopping out of his gut at the diner table.
The man had had the operation 15 days prior to the incident, with his wound staples only having been removed that very morning, according to a new paper in the American Journal of Medical Case Reports.
"During breakfast, the man sneezed forcefully, followed by coughing. He immediately noticed a "wet" sensation and pain in his lower abdomen. Looking down, he observed several loops of pink bowel protruding from his recent surgical site," the researchers wrote in the paper.
"He later related that he was unsure of how to proceed, so he covered the exposed intestines with his shirt. He initially decided to drive himself to the hospital, but concerned that changing his position might injure his bowel, his wife requested an ambulance."
"He and his wife went to breakfast to celebrate" his having his staples removed that morning, the researchers said.
The ambulance arrived at the diner rapidly and found that "large amounts of bowel" were poking through about 3 inches of his wound, with very little bleeding. According to the paper, a paramedic had considered pushing the guts back inside the man but decided against this to avoid any possible injuries to the bowel. Instead, she covered the intestines with a pad and secured it to the man, giving him painkillers for the journey to the hospital.
The urology service was consulted immediately when he arrived at the emergency department. His vital signs were within normal limits, and preoperative blood tests were obtained and noted to be unchanged from recent comparisons. A nasogastric tube was inserted, and the patient consented to receive an exploratory laparotomy.
"Three Urologic surgeons carefully reduced the eviscerated bowel back into the abdominal cavity. They inspected the full length of the small bowel and noted no evidence of injury," the researchers wrote. "The suture line was noted to have dehisced at its center and was closed with a variety of sutures."
Sneezing is a reflex action of the body to expel irritants from the nasal cavity. When foreign particles like dust, pollen, smoke, or strong smells enter the nasal passages, they can irritate the mucous membranes. The body responds by sending a burst of air to be expelled forcefully through the nose and mouth, which can travel at up to 100 miles per hour.
This isn't the only type of injury that can occur from sneezing: there have been previous reports of lung herniations through the ribs, lung tearing, and even brain tissue tearing after a sneeze. The increased blood pressure during a sneeze has previously led to tearing of the aorta, which can be deadly, as well as fracturing bones in the face.
In this case, the man was suffering from wound dehiscence, which occurs when a wound doesn't heal properly, causing the edges to separate. It is a common complication of the operation that the man had received, with around 7 percent of cystectomies resulting in dehiscence of some form, according to a 2023 paper.
"While wound dehiscence is a well-known complication, this case is important because evisceration through the abdominal surgical site after cystectomy is poorly described in the medical literature. A PubMed search for 'cystectomy AND evisceration' performed in May 2024 provided only 7 results related to evisceration through the abdominal wall after cystectomy," the researchers wrote.
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