A 63-year-old man may have had the worst case of the sneezes in history. During breakfast at a diner, he sneezed and coughed, causing his small intestine to eviscerate through a previously healed surgical site. His bowels were literally exposed and protruding.

The patient, initially unsure of how to handle the exposed intestines, covered them with his shirt. Meanwhile, his wife wisely called for an ambulance instead of driving to the hospital, which might have further injured the organ. When the ambulance arrived, the paramedic, confronted with this unusual situation, opted to keep the area moist using saline-soaked pads until the patient arrived in hospital.

In the emergency room, the patient underwent immediate surgical intervention. The medical team, including three urologic surgeons, carefully reduced the bowel back into the abdominal cavity. They inspected the bowel for injury, irrigated the peritoneal cavity, and securely closed the wound with a variety of sutures. The patient recovered well post-operatively, with no signs of bowel injury and was discharged in good condition.

An Odd Clinical Case

Two weeks before this dramatic episode, the patient had undergone a cystectomy, a surgical procedure meant to remove the entire urinary bladder, typically because of cancer.

“Though wound dehiscence is a known post-operative complication, bowel evisceration through the abdominal wall after cystectomy has rarely been reported,” doctors wrote in a recent report detailing this extraordinary case.

The doctors mention that this is not the only case of evisceration through the abdominal surgical site after cystectomy, although such events are extremely rare and poorly understood.

This case underscores the need for first responders and medical professionals to be prepared for rare but serious complications following abdominal surgeries. It also suggests that emergency medical protocols may need to include specific guidelines for handling bowel evisceration to ensure optimal patient outcomes.

“Emergency Medical Services medical directors might consider incorporating the guidelines for abdominal evisceration published by Tactical Combat Casualty Care, including: control visible bleeding, address gross contamination by rinsing the bowel with sterile saline or sterile water, cover the exposed bowel with a ‘moist, sterile dressing or a sterile water-impermeable covering,’ and irrigate these dressings as needed with additional sterile fluid,” the authors wrote.

The findings appeared in the American Journal of Medical Case Reports.