Have you ever sneezed and felt like some of your organs were about to spill out? Well, for one unlucky man in Florida, that was more than just a feeling.
The 63-year-old man was having breakfast with his wife at a restaurant when he suddenly sneezed violently and then began coughing, the newspaper reported. American Journal of Medical Case ReportsAfter noticing a “wet” sensation and pain in his lower abdomen, he looked down and discovered “several loops” of pink intestine protruding from a wound from a recent surgery outside his body.
But don’t worry, this isn’t a normal occurrence for everyone who suffers a gastric laceration. According to the case report, abdominal evisceration was a rare complication of abdominal surgery that this man underwent 15 days prior to the incident.
In his case, a history of prostate cancer and recent radiation treatments led to a cystectomy, or surgery to remove his bladder. The operation was successful, and he was discharged in good spirits, returning to the urology clinic the morning he had his violent sneeze. Doctors then removed the staples that had been attached to the wound. The wound “appeared to be healing well,” so he and his wife went to a restaurant to celebrate.
A medical journal report noted that patients who have had evisceration surgery “may not know how to protect their exposed intestines,” and it’s no exaggeration to say that this man was in that group. Later, as he recalled the incident, the man said that out of fear, he had covered his intestines with his shirt and driven himself to the hospital, but that his wife called an ambulance because she was worried that moving him would damage his intestines.
Paramedics who arrived four minutes later also said they didn’t know what to do because their medical protocols didn’t include guidelines for evisceration. Their initial idea was to put “a lot of intestines” back into the man through a three-inch gash that was causing minimal bleeding, but they abandoned that idea for fear of damaging the intestines further.
Instead, the paramedics covered the exposed intestines with saline-moistened abdominal pads (a procedure they remembered from watching a lecture on keeping penetrating injuries moist) and wrapped the abdomen with rolls of gauze to immobilize it before administering pain medication.
The man arrived at the hospital with vital signs “within normal limits,” and in the operating room, three surgeons examined the entire length of the intestine, finding it to be intact, before “carefully reducing” it and placing it back into the abdominal cavity. They then closed the wound “with a variety of sutures.”
Six days later, the man was discharged in good condition after a “reassuring abdominal examination.”
Although wound dehiscence (reopening of surgical incisions) is a well-known complication of open cystectomy, viscera prolapse through the abdominal wall is rare following this procedure, with only seven known cases reported to date, according to case reports.
An analysis of 2023 cystectomy cases found that 6.9% reported some form of postoperative wound dehiscence, and other studies have cited high BMI and chronic obstructive pulmonary disease as two predictors, neither of which the man in this study had. However, the latter was thought to be a predictor because it can cause coughing, which can induce wound dehiscence through increased abdominal pressure. Therefore, the case report states that coughing after a sneeze may have caused the man’s internal organs to prolapse.